Robotic surgical controls having feedback capabilities

ABSTRACT

An input control device is disclosed. The input control device can be configured to operate in different modes depending on proximity data provided by a proximity detection system. The input control device can include a feedback generator configured to generate feedback in response to the input control device switching between operational modes, the proximity data provided by the proximity detection system, and/or other conditions of the surgical procedure, robotic surgical tool, surgical site, and/or patient. The input control device can include a variable resistance assembly for resisting input control motions applied to an actuator thereof. Additionally or alternatively, the input control device can include an end effector actuator assembly for repositioning the end effector actuator based on feedback from a paired robotic surgical tool.

BACKGROUND

Surgical systems often incorporate an imaging system, which can allowthe clinician(s) to view the surgical site and/or one or more portionsthereof on one or more displays such as a monitor. The display(s) can belocal and/or remote to a surgical theater. An imaging system can includea scope with a camera that views the surgical site and transmits theview to a display that is viewable by a clinician. Imaging systems canbe limited by the information that they are able to recognize and/orconvey to the clinician(s). For example, certain concealed structures,physical contours, and/or dimensions within a three-dimensional spacemay be unrecognizable intraoperatively by certain imaging systems.Additionally, certain imaging systems may be incapable of communicatingand/or conveying certain information to the clinician(s)intraoperatively.

Robotic systems can be actuated or remotely-controlled by one or moreclinicians positioned at control consoles. Input motions at the controlconsole(s) can correspond to actuations of a robotic arm and/or arobotic tool coupled thereto. In various instances, the robotic systemand/or the clinician(s) can rely on views and/or information provided byan imaging system to determine the desired robotic actuations and/or thecorresponding suitable input motions. The inability of certain imagingsystems to provide certain visualization data and/or information maypresent challenges and/or limits to the decision-making process of theclinician and/or the controls for the robotic system.

SUMMARY

In various aspects, a control system for a robotic surgical system isdisclosed, the control system including a surgical tool movable withrespect to a tissue of a patient and an input control device configuredto receive an input control motion. The input control device includes afeedback generator. The control system further includes a controlcircuit configured to receive an input control signal indicative of theinput control motion received by the input control device, provide afirst output control signal to the surgical tool based on the inputcontrol signal, determine a distance between the surgical tool and thetissue, and provide a second output control signal to the feedbackgenerator based on the distance reaching a threshold distance.

In various aspects, a control system for a robotic surgical system isdisclosed, the control system including a surgical tool movable withrespect to a tissue of a patient and an input control device including abase and a forearm support. The forearm support is movable relative tothe base within a first zone upon receipt of a precision input controlmotion to the forearm support. The forearm support is moveable relativeto the base within a second zone upon receipt of a gross input controlmotion to the forearm support. The input control device further includesa feedback generator. The control system further includes a controlcircuit configured to receive an input control signal indicative of theprecision input control motion and the gross input control motion,provide an output control signal to the surgical tool based on the inputcontrol signal, and provide a feedback signal to the feedback generatorin response to the forearm support transitioning between the first zoneand the second zone.

In various aspects, a control system for a robotic surgical system isdisclosed, the control system including an input control deviceconfigured to receive input control motions. The input control device isconfigured to operate in a first operational mode and a secondoperational mode. The input control device includes a feedbackgenerator. The control system further includes a control circuitconfigured to receive input control signals indicative of the inputcontrol motions received by the input control device, switch the inputcontrol device between the first operational mode and the secondoperational mode, provide first output control signals based on theinput control signals in the first operational mode and provide secondoutput control signals based on the input control signals in the secondoperational mode, and provide a feedback signal to the feedbackgenerator in response to the input control device switching between thefirst operational mode and the second operational mode. The secondoutput control signals are different than the first output controlsignals.

FIGURES

The novel features of the various aspects are set forth withparticularity in the appended claims The described aspects, however,both as to organization and methods of operation, may be best understoodby reference to the following description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 is a plan view of a robotic surgical system being used to performa surgery, according to at least one aspect of the present disclosure.

FIG. 2 is a perspective view of a surgeon's control console of therobotic surgical system of FIG. 1, according to at least one aspect ofthe present disclosure.

FIG. 3 is a diagram of a robotic surgical system, according to at leastone aspect of the present disclosure.

FIG. 4 is a perspective view of a surgeon's control console of a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 5 is a perspective view of a user input device at a surgeon'scontrol console, according to at least one aspect of the presentdisclosure.

FIG. 6 is a perspective view of a user input device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 7 is a plan view of the user input device of FIG. 6, according toat least one aspect of the present disclosure.

FIG. 8 is a rear elevation view of the user input device of FIG. 6,according to at least one aspect of the present disclosure.

FIG. 9 is a side elevation view of the user input device of FIG. 6,according to at least one aspect of the present disclosure.

FIG. 10 is a perspective view of a user's hand engaged with the userinput device of FIG. 6, according to at least one aspect of the presentdisclosure.

FIG. 11 is a rear elevation view of a user's hand engaged with the userinput device of FIG. 6, according to at least one aspect of the presentdisclosure.

FIG. 11A is a control logic flowchart for the user input device of FIG.6, according to at least one aspect of the present disclosure.

FIG. 11B is a table depicting control parameters for operational modesof the user input device of FIG. 6, according to at least one aspect ofthe present disclosure.

FIG. 11C illustrates a control circuit configured to control aspects ofthe user input device of FIG. 6, according to at least one aspect of thepresent disclosure.

FIG. 11D illustrates a combinational logic circuit configured to controlaspects of the user input device of FIG. 6, according to at least oneaspect of the present disclosure.

FIG. 11E illustrates a sequential logic circuit configured to controlaspects of the user input device of FIG. 6, according to at least oneaspect of the present disclosure.

FIG. 12 is a perspective view of an end effector of a surgical tooloperably controllable by control motions supplied to the user inputdevice of FIG. 6, according to at least one aspect of the presentdisclosure.

FIG. 12A is a perspective view of the end effector of FIG. 12, depictingthe end effector in an articulated configuration, according to at leastone aspect of the present disclosure.

FIGS. 13A and 13B depict an end effector of a surgical tool and the userinput device of FIG. 6 in corresponding open configurations, whereinFIG. 13A is a plan view of the end effector and FIG. 13B is a plan viewof the user input device, according to at least one aspect of thepresent disclosure.

FIGS. 14A and 14B depict the end effector and the user input device ofFIGS. 13A and 13B in corresponding partially-closed configurations,wherein FIG. 14A is a plan view of the end effector and FIG. 14B is aplan view of the user input device, according to at least one aspect ofthe present disclosure.

FIGS. 15A and 15B depict the end effector and the user input device ofFIGS. 13A and 13B in corresponding closed configurations, wherein FIG.15A is a plan view of the end effector and FIG. 15B is a plan view ofthe user input device, according to at least one aspect of the presentdisclosure.

FIG. 16 is a perspective view of a workspace including two of the userinput devices of FIG. 6 positioned on a surface, according to at leastone aspect of the present disclosure.

FIG. 17 is another perspective view of the workspace of FIG. 16,according to at least one aspect of the present disclosure.

FIG. 17A is a detail view of a portion of the workspace of FIG. 17,according to at least one aspect of the present disclosure.

FIG. 18 is an exploded perspective view of an input device includingfirst and second board members, a light shield, a stop arrangement, anda cap, according to at least one aspect of the present disclosure.

FIG. 19 is an exploded top perspective view of the first and secondboard members and the light shield of FIG. 18, according to at least oneaspect of the present disclosure.

FIG. 20 is an exploded bottom perspective view of the first and secondboard members and the light shield of FIG. 19, according to at least oneaspect of the present disclosure.

FIG. 21 is a plan view of pin members of the stop arrangement of FIG. 18positioned in openings in the second board member of FIG. 18 in arotated configuration, according to at least one aspect of the presentdisclosure.

FIG. 22 is cross-sectional elevation view of the first and second boardmembers, the light shield, the stop arrangement, and the cap of FIG. 18in a tilted configuration, according to at least one aspect of thepresent disclosure.

FIG. 23 is a cross-sectional elevation view of a user input device,according to at least one aspect of the present disclosure.

FIG. 24 is a schematic of a surgical visualization system including animaging device and a surgical device, the surgical visualization systemconfigured to identify a critical structure below a tissue surface,according to at least one aspect of the present disclosure.

FIG. 25 is a schematic of a control system for a surgical visualizationsystem configured to receive inputs from a user input device, accordingto at least one aspect of the present disclosure.

FIG. 26 illustrates a control circuit configured to control aspects of asurgical visualization system, according to at least one aspect of thepresent disclosure.

FIG. 27 illustrates a combinational logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 28 illustrates a sequential logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 29 is a schematic depicting triangularization to determine a depthd_(A) of a critical structure below the tissue surface, according to atleast one aspect of the present disclosure.

FIG. 30 is a schematic of a surgical visualization system configured toidentify a critical structure below a tissue surface, wherein thesurgical visualization system includes a pulsed light source fordetermining a depth d_(A) of the critical structure below the tissuesurface, according to at least one aspect of the present disclosure.

FIG. 31 is a schematic of a surgical visualization system including athree-dimensional camera, wherein the surgical visualization system isconfigured to identify a critical structure that is embedded withintissue, according to at least one aspect of the present disclosure.

FIGS. 32A and 32B are views of the critical structure taken by thethree-dimensional camera of FIG. 31, in which FIG. 32A is a view from aleft-side lens of the three-dimensional camera and FIG. 32B is a viewfrom a right-side lens of the three-dimensional camera, according to atleast one aspect of the present disclosure.

FIG. 33 is a schematic of the surgical visualization system of FIG. 31,in which a camera-to-critical structure distance d_(w), from thethree-dimensional camera to the critical structure can be determined,according to at least one aspect of the present disclosure.

FIG. 34 is a schematic of a surgical visualization system utilizing twocameras to determine the position of an embedded critical structure,according to at least one aspect of the present disclosure.

FIG. 35A is a schematic of a surgical visualization system utilizing acamera that is moved axially between a plurality of known positions todetermine a position of an embedded critical structure, according to atleast one aspect of the present disclosure.

FIG. 35B is a schematic of the surgical visualization system of FIG.35A, in which the camera is moved axially and rotationally between aplurality of known positions to determine a position of the embeddedcritical structure, according to at least one aspect of the presentdisclosure.

FIG. 36 is a schematic of a control system for a surgical visualizationsystem, according to at least one aspect of the present disclosure.

FIG. 37 is a schematic of a structured light source for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

FIGS. 38-40 depict illustrative hyperspectral identifying signatures todifferentiate anatomy from obscurants, wherein FIG. 38 is a graphicalrepresentation of a ureter signature versus obscurants, FIG. 39 is agraphical representation of an artery signature versus obscurants, andFIG. 40 is a graphical representation of a nerve signature versusobscurants, according to at least one aspect of the present disclosure.

FIG. 41 is a schematic of a near infrared (NIR) time-of-flightmeasurement system configured to sense distance to a critical anatomicalstructure, the time-of-flight measurement system including a transmitter(emitter) and a receiver (sensor) positioned on a common device,according to at least one aspect of the present disclosure.

FIG. 42 is a schematic of an emitted wave, a received wave, and a delaybetween the emitted wave and the received wave of the NIR time-of-flightmeasurement system of FIG. 41, according to at least one aspect of thepresent disclosure.

FIG. 43 illustrates a NIR time-of-flight measurement system configuredto sense a distance to different structures, the time-of-flightmeasurement system including a transmitter (emitter) and a receiver(sensor) on separate devices, according to at least one aspect of thepresent disclosure.

FIG. 44 is a perspective view of an input control device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 45 is another perspective view of the input control device of FIG.44, according to at least one aspect of the present disclosure.

FIG. 46 is a front elevation view of the input control device of FIG.44, according to at least one aspect of the present disclosure.

FIG. 47 is a side elevation view of the input control device of FIG. 44in a first configuration illustrated with solid lines and furtherdepicting the input control device in a second configuration illustratedwith dashed lines, wherein a lower portion, or base, of the inputcontrol device remains stationary and an upper portion of the inputcontrol device is displaced along a longitudinal axis between the firstconfiguration and the second configuration, according to at least oneaspect of the present disclosure.

FIG. 48 is a perspective view of a user's hand and forearm engaged withthe input control device of FIG. 44, according to at least one aspect ofthe present disclosure.

FIG. 49 is a front elevation view of a user's hand and forearm engagedwith the input control device of FIG. 44, according to at least oneaspect of the present disclosure.

FIG. 50 is a logic diagram for a control circuit utilized in connectionwith the input control device of FIG. 44, according to at least oneaspect of the present disclosure.

FIG. 51 is a logic diagram for a control circuit utilized in connectionwith the input control device of FIG. 44, according to at least oneaspect of the present disclosure.

FIG. 52 is a side elevation view of an input control device includingfeedback generators, according to at least one aspect of the presentdisclosure.

FIG. 53 is a plan view of travel zones for the input control device ofFIG. 52, according to at least one aspect of the present disclosure.

FIG. 54 is a side elevation view of an input control device includingfeedback generators, according to at least one aspect of the presentdisclosure.

FIG. 55 is a plan view of an input control device including a variableresistance assembly, according to at least one aspect of the presentdisclosure.

FIG. 56 is a graphical representation of voltage (V) over tissue force(_(tissue)) for the variable resistance assembly of FIG. 55, accordingto at least one aspect of the present disclosure.

FIG. 57 is a graphical representation of resistance force( ) over tissueforce( ) for the variable resistance assembly of FIG. 55, according toat least one aspect of the present disclosure.

FIG. 58 is a logic diagram for a control circuit utilized in connectionwith the input control device of FIG. 55, according to at least oneaspect of the present disclosure.

FIG. 59 is a plan view of an input control device including a linear jawactuator, according to at least one aspect of the present disclosure.

FIG. 60 is an elevation view of a linear jaw actuator for an inputcontrol device, according to at least one aspect of the presentdisclosure.

FIG. 61 is a plan view of a pair of linear jaw actuators for an inputcontrol device, according to at least one aspect of the presentdisclosure.

FIG. 62 is a table depicting jaw angles of the input control device ofFIG. 59 and jaw angles of various robotic surgical tools throughout asurgical procedure, according to at least one aspect of the presentdisclosure.

FIG. 63 is a logic diagram for a control circuit utilized in connectionwith the input control device of FIG. 59, according to at least oneaspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 15, 2019, each of which is hereinincorporated by reference in its entirety:

-   -   Attorney Docket No. END9052USNP1/180620-1, titled INPUT CONTROLS        FOR ROBOTIC SURGERY;    -   Attorney Docket No. END9052USNP2/180620-2, titled DUAL MODE        CONTROLS FOR ROBOTIC SURGERY;    -   Attorney Docket No. END9052USNP3/180620-3, tided MOTION CAPTURE        CONTROLS FOR ROBOTIC SURGERY;    -   Attorney Docket No. END9053USNP1/180621-1, titled ROBOTIC        SURGICAL SYSTEMS WITH MECHANISMS FOR SCALING SURGICAL TOOL        MOTION ACCORDING TO TISSUE PROXIMITY;    -   Attorney Docket No. END9053USNP2/180621-2, titled ROBOTIC        SURGICAL SYSTEMS WITH MECHANISMS FOR SCALING CAMERA        MAGNIFICATION ACCORDING TO PROXIMITY OF SURGICAL TOOL TO TISSUE;    -   Attorney Docket No. END9053USNP3/180621-3, tided ROBOTIC        SURGICAL SYSTEMS WITH SELECTIVELY LOCKABLE END EFFECTORS;    -   Attorney Docket No. END9053USNP4/180621-4, tided SELECTABLE        VARIABLE RESPONSE OF SHAFT MOTION OF SURGICAL ROBOTIC SYSTEMS;    -   Attorney Docket No. END9054USNP1/180622-1, titled SEGMENTED        CONTROL INPUTS FOR SURGICAL ROBOTIC SYSTEMS;    -   Attorney Docket No. END9055USNP2/180623-2, titled ROBOTIC        SURGICAL CONTROLS WITH FORCE FEEDBACK; and    -   Attorney Docket No. END9055USNP3/180623-3, tided JAW        COORDINATION OF ROBOTIC SURGICAL CONTROLS.

Applicant of the present application also owns the following U.S. PatentApplications, filed on Sep. 11, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/128,179, tided SURGICAL        VISUALIZATION PLATFORM;    -   U.S. patent application Ser. No. 16/128,180, titled CONTROLLING        AN EMITTER ASSEMBLY PULSE SEQUENCE;    -   U.S. patent application Ser. No. 16/128,198, titled SINGULAR EMR        SOURCE EMITTER ASSEMBLY;    -   U.S. patent application Ser. No. 16/128,207, tided COMBINATION        EMITTER AND CAMERA ASSEMBLY;    -   U.S. patent application Ser. No. 16/128,176, titled SURGICAL        VISUALIZATION WITH PROXIMITY TRACKING FEATURES;    -   U.S. patent application Ser. No. 16/128,187, tided SURGICAL        VISUALIZATION OF MULTIPLE TARGETS;    -   U.S. patent application Ser. No. 16/128,192, titled        VISUALIZATION OF SURGICAL DEVICES;    -   U.S. patent application Ser. No. 16/128,163, tided OPERATIVE        COMMUNICATION OF LIGHT;    -   U.S. patent application Ser. No. 16/128,197, tided ROBOTIC LIGHT        PROJECTION TOOLS;    -   U.S. patent application Ser. No. 16/128,164, titled SURGICAL        VISUALIZATION FEEDBACK SYSTEM;    -   U.S. patent application Ser. No. 16/128,193, titled SURGICAL        VISUALIZATION AND MONITORING;    -   U.S. patent application Ser. No. 16/128,195, titled INTEGRATION        OF IMAGING DATA;    -   U.S. patent application Ser. No. 16/128,170, titled        ROBOTICALLY-ASSISTED SURGICAL SUTURING SYSTEMS;    -   U.S. patent application Ser. No. 16/128,183, titled SAFETY LOGIC        FOR SURGICAL SUTURING SYSTEMS;    -   U.S. patent application Ser. No. 16/128,172, titled ROBOTIC        SYSTEM WITH SEPARATE

PHOTOACOUSTIC RECEIVERS; and

-   -   U.S. patent application Ser. No. 16/128,185, titled FORCE SENSOR        THROUGH STRUCTURED LIGHT DEFLECTION.

Applicant of the present application also owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,627, titled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,676, titled AUTOMATIC        TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,711, titled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and    -   U.S. patent application Ser. No. 15/940,722, titled        CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF        MONO-CHROMATIC LIGHT REFRACTIVITY.

Before explaining various aspects of a robotic surgical platform indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

Robotic Systems

An exemplary robotic system 110 is depicted in FIG. 1. The roboticsystem 110 is a minimally invasive robotic surgical (MIRS) systemtypically used for performing a minimally invasive diagnostic orsurgical procedure on a patient 112 who is lying down on an operatingtable 114. The robotic system 110 includes a surgeon's console 116 foruse by a surgeon 118 during the procedure. One or more assistants 120may also participate in the procedure. The robotic system 110 canfurther include a patient side cart 122, i.e. a surgical robot, and anelectronics cart 124. The surgical robot 122 can manipulate at least oneremovably coupled tool assembly 126 (hereinafter referred to as a“tool”) through a minimally invasive incision in the body of the patient112 while the surgeon 118 views the surgical site through the console116. An image of the surgical site can be obtained by an imaging devicesuch as a stereoscopic endoscope 128, which can be manipulated by thesurgical robot 122 to orient the endoscope 128. Alternative imagingdevices are also contemplated.

The electronics cart 124 can be used to process the images of thesurgical site for subsequent display to the surgeon 118 through thesurgeon's console 116. In certain instances, the electronics of theelectronics cart 124 can be incorporated into another structure in theoperating room, such as the operating table 114, the surgical robot 122,the surgeon's console 116, and/or another control station, for example.The number of robotic tools 126 used at one time will generally dependon the diagnostic or surgical procedure and the space constraints withinthe operating room among other factors. If it is necessary to change oneor more of the robotic tools 126 being used during a procedure, anassistant 120 may remove the robotic tool 126 from the surgical robot122 and replace it with another tool 126 from a tray 130 in theoperating room.

Referring primarily to FIG. 2, the surgeon's console 116 includes a lefteye display 132 and a right eye display 134 for presenting the surgeon118 with a coordinated stereo view of the surgical site that enablesdepth perception. The console 116 further includes one or more inputcontrol devices 136, which in turn cause the surgical robot 122 tomanipulate one or more tools 126. The input control devices 136 canprovide the same degrees of freedom as their associated tools 126 toprovide the surgeon with telepresence, or the perception that the inputcontrol devices 136 are integral with the robotic tools 126 so that thesurgeon has a strong sense of directly controlling the robotic tools126. To this end, position, force, and tactile feedback sensors may beemployed to transmit position, force, and tactile sensations from therobotic tools 126 back to the surgeon's hands through the input controldevices 136. The surgeon's console 116 can be located in the same roomas the patient 112 so that the surgeon 118 may directly monitor theprocedure, be physically present if necessary, and speak to an assistant120 directly rather than over the telephone or other communicationmedium. However, the surgeon 118 can be located in a different room, acompletely different building, or other remote location from the patient112 allowing for remote surgical procedures. A sterile field can bedefined around the surgical site. In various instances, the surgeon 118can be positioned outside the sterile field.

Referring again to FIG. 1, the electronics cart 124 can be coupled withthe endoscope 128 and can include a processor to process captured imagesfor subsequent display, such as to a surgeon on the surgeon's console116, or on another suitable display located locally and/or remotely. Forexample, when the stereoscopic endoscope 128 is used, the electronicscart 124 can process the captured images to present the surgeon withcoordinated stereo images of the surgical site. Such coordination caninclude alignment between the opposing images and can include adjustingthe stereo working distance of the stereoscopic endoscope. As anotherexample, image processing can include the use of previously-determinedcamera calibration parameters to compensate for imaging errors of theimage capture device, such as optical aberrations, for example. Invarious instances, the robotic system 110 can incorporate a surgicalvisualization system, as further described herein, such that anaugmented view of the surgical site that includes hidden criticalstructures, three-dimensional topography, and/or one or more distancescan be conveyed to the surgeon at the surgeon's console 116.

FIG. 3 diagrammatically illustrates a robotic surgery system 150, suchas the MIRS system 110 (FIG. 1). As discussed herein, a surgeon'sconsole 152, such as the surgeon's console 116 (FIGS. 1 and 2), can beused by a surgeon to control a surgical robot 154, such as the surgicalrobot 122 (FIG. 1), during a minimally invasive procedure. The surgicalrobot 154 can use an imaging device, such as a stereoscopic endoscope,for example, to capture images of the surgical site and output thecaptured images to an electronics cart 156, such as the electronics cart124 (FIG. 1). As discussed herein, the electronics cart 156 can processthe captured images in a variety of ways prior to any subsequentdisplay. For example, the electronics cart 156 can overlay the capturedimages with a virtual control interface prior to displaying the combinedimages to the surgeon via the surgeon's console 152. The surgical robot154 can output the captured images for processing outside theelectronics cart 156. For example, the surgical robot 154 can output thecaptured images to a processor 158, which can be used to process thecaptured images. The images can also be processed by a combination ofthe electronics cart 156 and the processor 158, which can be coupledtogether to process the captured images jointly, sequentially, and/orcombinations thereof. One or more separate displays 160 can also becoupled with the processor 158 and/or the electronics cart 156 for localand/or remote display of images, such as images of the surgical site, orother related images.

The reader will appreciate that various robotic tools can be employedwith the surgical robot 122 and exemplary robotic tools are describedherein. Referring again to FIG. 1, the surgical robot 122 shown providesfor the manipulation of three robotic tools 126 and the imaging device128, such as a stereoscopic endoscope used for the capture of images ofthe site of the procedure, for example Manipulation is provided byrobotic mechanisms having a number of robotic joints. The imaging device128 and the robotic tools 126 can be positioned and manipulated throughincisions in the patient so that a kinematic remote center or virtualpivot is maintained at the incision to minimize the size of theincision. Images of the surgical site can include images of the distalends of the robotic tools 126 when they are positioned within thefield-of-view (FOV) of the imaging device 128. Each tool 126 isdetachable from and carried by a respective surgical manipulator, whichis located at the distal end of one or more of the robotic joints. Thesurgical manipulator provides a moveable platform for moving theentirety of a tool 126 with respect to the surgical robot 122, viamovement of the robotic joints. The surgical manipulator also providespower to operate the robotic tool 126 using one or more mechanicaland/or electrical interfaces. In various instances, one or more motorscan be housed in the surgical manipulator for generating controlsmotions. One or more transmissions can be employed to selectively couplethe motors to various actuation systems in the robotic tool.

The foregoing robotic systems are further described in U.S. patentapplication Ser. No. 15/940,627, titled DRIVE ARRANGEMENTS FORROBOT-ASSIS 1ED SURGICAL PLATFORMS, filed Mar. 29, 2018, which isincorporated by reference herein in its entirety. Alternative roboticsystems are also contemplated.

Referring now to FIG. 4, a surgeon's console, or control unit, 250 isshown. The surgeon's console 250 can be used in connection with arobotic system to control any two surgical tools coupled to the roboticsystem. The surgical tools can be controlled by the handle assemblies256 of the surgeon's console 250. For example, the handle assemblies 256and robotic arms have a master-slave relationship so that movement ofthe handle assemblies 256 produces a corresponding movement of thesurgical tools. A controller 254 receives input signals from the handleassemblies 256, computes a corresponding movement of the surgical tools,and provides output signals to move the robotic arms and the surgicaltools.

The handle assemblies 256 are located adjacent to a surgeon's chair 258and coupled to the controller 254. The controller 254 may include one ormore microprocessors, memory devices, drivers, etc. that convert inputinformation from the handle assemblies 256 into output control signalswhich move the robotic arms and/or actuate the surgical tools. Thesurgeon's chair 258 and the handle assemblies 256 may be in front of avideo console 248, which can be linked to an endoscope to provide videoimages of the patient. The surgeon's console 250 may also include ascreen 260 coupled to the controller 254. The screen 260 may displaygraphical user interfaces (GUIs) that allow the surgeon to controlvarious functions and parameters of the robotic system.

Each handle assembly 256 includes a handle/wrist assembly 262. Thehandle/wrist assembly 262 has a handle 264 that is coupled to a wrist266. The wrist 266 is connected to a forearm linkage 268 that slidesalong a slide bar 270. The slide bar 270 is pivotally connected to anelbow joint 272. The elbow joint 272 is pivotally connected to ashoulder joint 274 that is attached to the controller 254. The surgeonsitting at the surgeon's console 250 can provide input control motionsto the handle assemblies 256 to effect movements and/or actuations of asurgical tool communicatively coupled thereto. For example, the surgeoncan advance the forearm linkage 268 along the slide bar 270 to advancethe surgical tool toward a surgical site. Rotations at the wrist 266,elbow joint 272, and/or shoulder joint 274 can effect rotation and/orarticulation of the surgical tool about the corresponding axes. Therobotic system and surgeon's console 250 are further described in U.S.Pat. No. 6,951,535, titled TELE-MEDICINE SYSTEM THAT TRANSMITS AN ENTIRESTATE OF A SUBSYSTEM, which issued Oct. 4, 2005, the entire disclosureof which is incorporated by reference herein.

A handle assembly for use at a surgeon's console is further depicted inFIG. 5. The handle assembly of FIG. 5 includes a control input wrist 352and a touch sensitive handle 325. The control input wrist 352 is agimbaled device that pivotally supports the touch sensitive handle 325to generate control signals that are used to control a robotic surgicalmanipulator and the robotic surgical tools. A pair of control inputwrists 352 and touch sensitive handles 325 can be supported by a pair ofcontrol input arms in a workspace of the surgeon's console.

The control input wrist 352 includes first, second, and third gimbalmembers 362, 364, and 366, respectively. The third gimbal member 366 canbe rotationally mounted to a control input arm. The touch sensitivehandle 325 include a tubular support structure 351, a first grip 350A,and a second grip 350B. The first grip 350A and the second grip 350B aresupported at one end by the tubular support structure 351. The touchsensitive handle 325 can be rotated about axis G. The grips 350A, 350Bcan be squeezed or pinched together about the tubular support structure351. The “pinching” or grasping degree of freedom in the grips isindicated by arrows Ha and Hb.

The touch sensitive handle 325 is rotatably supported by the firstgimbal member 362 by means of a rotational joint 356g. The first gimbalmember 362 is in turn, rotatably supported by the second gimbal member364 by means of the rotational joint 356f. Similarly, the second gimbalmember 364 is rotatably supported by the third gimbal member 366 using arotational joint 356e. In this manner, the control input wrist 352allows the touch sensitive handle 325 to be moved and oriented in theworkspace using three degrees of freedom.

The movements in the gimbals 362, 364, 366 of the control input wrist352 to reorient the touch sensitive handle 325 in space can betranslated into control signals to control a robotic surgicalmanipulator and the robotic surgical tools. The movements in the grips350A and 350B of the touch sensitive handle 325 can also be translatedinto control signals to control the robotic surgical manipulator and therobotic surgical tools. In particular, the squeezing motion of the grips350A and 350B over their freedom of movement indicated by arrows Ha andHb, may be used to control the end effectors of the robotic surgicaltools.

To sense the movements in the touch sensitive handle 325 and generatecontrols signals, sensors can be mounted in the handle 325 as well asthe first gimbal member 362 of the control input wrist 352. Exemplarysensors may be a pressure sensor, Hall Effect transducer, apotentiometer, and/or an encoder, for example. The robotic surgicalsystems and handle assembly of FIG. 5 are further described in U.S. Pat.No. 8,224,484, titled METHODS OF USER INTERFACE WITH ALTERNATIVE TOOLMODE FOR ROBOTIC SURGICAL TOOLS, which issued Jul. 17, 2012, the entiredisclosure of which is incorporated by reference herein.

Existing robotic systems can incorporate a surgical visualizationsystem, as further described herein. In such instances, additionalinformation regarding the surgical site can be determined and/orconveyed to the clinician(s) in the surgical theater, such as to asurgeon positioned at a surgeon's console. For example, the clinician(s)can observe an augmented view of reality of the surgical site thatincludes additional information such as various contours of the tissuesurface, hidden critical structures, and/or one or more distances withrespect to anatomical structures. In various instances, proximity datacan be leveraged to improve one or more operations of the roboticsurgical system and or controls thereof, as further described herein.

Input Control Devices

Referring again to the robotic system 150 in FIG. 3, the surgeon'sconsole 152 allows the surgeon to provide manual input commands to thesurgical robot 154 to effect control of the surgical tool and thevarious actuations thereof. Movement of an input control device by asurgeon at the surgeon's console 152 within a predefined working volume,or work envelope, results in a corresponding movement or operation ofthe surgical tool. For example, referring again to FIG. 2, a surgeon canengage each input control device 136 with one hand and move the inputcontrol devices 136 within the work envelope to provide control motionsto the surgical tool. Surgeon's consoles (e.g. the surgeon's console 116in FIGS. 1 and 2 and the surgeon's console 250 in FIG. 4) can beexpensive and require a large footprint. For example, the working volumeof the user input device (e.g. the handle/wrist assembly 262 in FIG. 4and the control input wrist 352 and touch sensitive handle 325 in FIG.5) at the surgeon's consoles can necessitate a large footprint, whichimpacts the usable space in the operating room (OR), trainingmodalities, and cooperative procedures, for example. For example, such alarge footprint can preclude the option of having multiple controlstations in the OR, such as additional control stations for training oruse by an assistant. Additionally, the size and bulkiness of a surgeon'sconsole can be cumbersome to relocate within an operating room or movebetween operating rooms, for example.

Ergonomics is an important consideration for surgeons who may spend manyhours each day in surgery and/or at the surgeon's console. Excessive,repetitive motions during surgical procedures can lead to fatigue andchronic injury for the surgeon. It can be desirable to maintain acomfortable posture and/or body position while providing inputs to therobotic system. However, in certain instances, the surgeon's postureand/or position may be compromised to ensure proper positioning of asurgical tool. For example, surgeons are often prone to contort theirhands and/or extend their arms for long durations of time. In oneinstance, a gross control motion to move the surgical tool to thesurgical site may result in the surgeon's arms being uncomfortably toooutstretched and/or cramped uncomfortably close upon reaching thesurgical site. In certain instances, poor ergonomic posturing achievedduring the gross control motion may be maintained during a subsequentfine control motion, e.g. when manipulating tissue at the surgical site,which can further exasperate the poor ergonomics for the surgeon.Existing input control devices propose a one-size-fits-all approachregardless of the surgeon's anthropometrics; however, the ergonomicimpact to a surgeon can vary and certain body types may be more burdenedby the architecture of existing input control devices.

In certain instances, an input control device can be restrained withinthe work envelope that defines its range of motion. For example, thestructure of the surgeon's console and/or the linkages on the inputcontrol device can limit the range of the motion of the input controldevice. In certain instances, the input control device can reach the endof its range of motion before the surgical tool is appropriatelypositioned. In such instances, a clutching mechanism can be required toreposition the input control device within the work envelope to completethe positioning of the surgical tool. A hypothetical work envelope 280is shown in FIG. 4, for example. In various instances, the surgeon canbe required to actuate a clutch (often in the form of a foot pedal oradditional button on the handle of the input control device) totemporarily disengage the input control device from the surgical toolwhile the input control device is relocated to a desired position withinthe work envelope. This non-surgical motion by the surgeon can bereferred to as a “rowing” motion to properly reposition the user inputdevice within the work envelope because of the arm motion of the surgeonat the surgeon's console. Upon release of the clutch, the motions of theinput control device can again control the surgical tool.

Clutching the input control device to maintain a suitable positionwithin the work envelope poses an additional cognitive burden to thesurgeon. In such instances, the surgeon is required to constantlymonitor the position and orientation of his/her hands relative to theboundaries of the work envelope. Additionally, the clutching or “rowing”motion can be tedious to the surgeon and such a monotonous, repetitivemotion does not match the analogous workflow of a surgical procedureoutside the context of robotic surgery. Clutching also requires thesurgeon to match a previous orientation of the handle when reengagingthe system. For example, upon completion of a complex range of motion inwhich the surgeon “rows” or clutches the input control device back to acomfortable, home position, the surgeon and/or surgical robot must matchthe orientation of the handle of the input control device in the homeposition to the previous orientation of the handle in the extendedposition, which can be challenging and/or require complex logic and/ormechanics.

Requiring a clutch mechanism also limits the availability of controls onthe handle of the input control device. For example, a clutch actuatorcan take up valuable real estate on the handle, which cognitively andphysically limits the availability of other controls on the handle Inturn, the complexity of other subsystems, such as a peddle board, isincreased and the surgeon may be required to utilize multiple inputsystems to complete a simple task.

Non-clutched alternatives to such input control devices can reduce thefootprint and cost of the surgeon's console, improve the surgeon'sergonomic experience, eliminate the physical and cognitive burdensassociated with clutching, and/or provide additional real estate on theinput control device for additional input controls, for example.Exemplary non-clutched input control devices are further describedherein. Such non-clutched input control devices can be employed with avariety of robotic systems. Moreover, as further described herein, thenon-clutched input control devices can leverage information from variousdistance determining subsystems also disclosed herein. For example,real-time structured light and three-dimensional shape modeling caninform the logic of such non-clutched input control devices such that afirst mode and/or first collection of controls are enabled outside apredefined distance from an anatomical surface and/or critical structureand a second mode and/or second collection of controls are enabledwithin a predefined distance of the anatomical structure and/or criticalstructure. Various tissue proximity applications are further describedherein.

Referring now to FIGS. 6-11, an input control device 1000 is shown. Theinput control device 1000 is a clutchless input control device, asfurther described herein. The input control device 1000 can be utilizedat a surgeon's console or workspace for a robotic surgical system. Forexample, the input control device 1000 can be incorporated into asurgical system, such as the surgical system 110 (FIG. 1) or thesurgical system 150 (FIG. 3), for example, to provide control signals toa surgical robot and/or surgical tool coupled thereto. The input controldevice 1000 includes input controls for moving the robotic arm and/orthe surgical tool in three-dimensional space. For example, the surgicaltool controlled by the input control device 1000 can be configured tomove and/or rotate relative to X, Y, and Z axes.

An exemplary surgical tool 1050 is shown in FIG. 12. The surgical tool1050 is a grasper that includes an end effector 1052 having opposingjaws 1054, which are configured to releasably grab tissue. The surgicaltool 1050 can be maneuvered in three dimensional space by translatingthe surgical tool 1050 along the X_(t), Y_(b) and Z_(t) axes thereof Thesurgical tool 1050 also includes a plurality of joints such that thesurgical tool can be rotated and/or articulated into a desiredconfiguration. The surgical tool 1050 can be configured to rotate orroll about the X_(t) axis defined by the longitudinal shaft of thesurgical tool 1050, rotate or articulate about a first articulation axisparallel to the Y_(t) axis, and rotate or articulate about a secondarticulation axis parallel to the Z_(t) axis. Rolling about the X_(t)axis corresponds to a rolling motion of the end effector 1052 in thedirection R_(t), articulation about the first articulation axiscorresponds to a pitching motion of the end effector 1052 in thedirection P_(b) and articulation about the second articulation axiscorresponds to a yawing or twisting motion in the direction T_(t).

An input control device, such as the input control device 1000, forexample, can be configured to control the translation and rotation ofthe end effector 1052. To control such motion, the input control device1000 includes corresponding input controls. For example, the inputcontrol device 1000 includes at least six degrees of freedom of inputcontrols for moving the surgical tool 1050 in three dimensional spacealong the X_(t), Y, and Z_(t) axes, for rolling the end effector 1052about the X_(t) axis, and for articulating the end effector 1052 aboutthe first and second articulation axes. Additionally, the input controldevice 1000 includes an end effector actuator for actuating the opposingjaws of the end effector 1052 to manipulate or grip tissue. Additionalfeatures of the input control device 1000 with respect to a surgicaltool, such as the surgical tool 1050, for example, are further describedherein.

Referring again to FIGS. 6-11, the input control device 1000 includes amulti-dimensional space joint 1006 having a central portion 1002supported on a base 1004. The base 1004 is structured to rest on asurface, such as a desk or work surface at a surgeon's console/workspaceor at the patient's bedside, for example. The base 1004 defines acircular base with a contoured edge; however, alternative geometries arecontemplated. The base 1004 can remain in a fixed, stationary positionrelative to an underlying surface upon application of the input controlsthereto. In certain instances, the base 1004 can be releasably securedand/or clamped to the underlying surface with fasteners, such asthreaded fasteners, for example. In other instances, fasteners may notbe required to hold the base 1004 to the underlying surface. In variousinstances, the base 1004 can include a sticky or tacking bottom surfaceand/or suction features (e.g. suction cups or magnets) for gripping anunderlying surface. In certain instances, the base 1004 can include aribbed and/or grooved bottom surface for engaging a complementaryunderlying support surface.

The space joint 1006 is configured to receive multi-dimensional manualinputs from a surgeon (e.g. the surgeon's hand or arm) corresponding tocontrol motions for the surgical tool in multi-dimensional space. Thecentral portion 1002 of the space joint 1006 is configured to receiveinput forces in multiple directions, such as forces along and/or aboutthe X, Y, and Z axes. The central portion 1002 can include a raising,lowering, and rotating cylinder, shaft, or hemisphere, for example,projecting from the base 1004. The central portion 1002 is flexiblysupported relative to the base 1004 such that the cylinder, shaft,and/or hemisphere is configured to move or float within a smallpredefined zone upon receipt of force control inputs thereto. Forexample, the central portion 1002 can be a floating shaft that issupported on the base 1004 by one or more elastomeric members such assprings, for example. The central portion 1002 can be configured to moveor float within a predefined three-dimensional volume. For example,elastomeric couplings can permit movement of the central portion 1002relative to the base 1004; however, restraining plates, pins, and/orother structures can be configured to limit the range of motion of thecentral portion 1002 relative to the base 1004. In one aspect, movementof the central portion 1002 from a central or “home” position relativeto the base 1004 can be permitted within a range of about 1.0 mm toabout 5.0 mm in any direction (up, down, left, right, backwards andforwards). In other instances, movement of the central portion 1002relative to the base 1004 can be restrained to less than 1.0 mm or morethan 5.0 mm. In certain instances, the central portion 1002 can moveabout 2.0 mm in all directions relative to the base 1004. In variousinstances, the space joint 1006 can be similar to a multi-dimensionalmouse, or space mouse. An exemplary space mouse is provided by3Dconnexion Inc. and described at www.d3connexion.com, for example.

In various instances, the space joint 1006 includes a multi-axis forceand/or torque sensor arrangement 1048 (see FIGS. 8 and 9) configured todetect the input forces and moments applied to the central portion 1002and transferred to the space joint 1006. The sensor arrangement 1048 ispositioned on one or more of the surfaces at the interface between thecentral portion 1002 and the base 1004. In other instances, the sensorarrangement 1048 can be embedded in the central portion 1002 or the base1004. In still other instances, the sensor arrangement 1048 can bepositioned on a floating member positioned intermediate the centralportion 1002 and the base 1004.

The sensor arrangement 1048 can include one or more resistive straingauges, optical force sensors, optical distance sensors, miniaturecameras in the range of about 1.0 mm to about 3.0 mm in size, and/ortime of flight sensors utilizing a pulsed light source, for example. Inone aspect, the sensor arrangement 1048 includes a plurality ofresistive strain gauges configured to detect the different force vectorsapplied thereto. The strain gauges can define a Wheatstone bridgeconfiguration, for example. Additionally or alternatively, the sensorarrangement 1048 can include a plurality of optoelectronic sensors, suchas measuring cells comprising a position-sensitive detector illuminatedby a light-emitting element, such as an LED. Alternative force-detectingsensor arrangements are also contemplated. Exemplary multi-dimensionalinput devices and/or sensor arrangements are further described in thefollowing references, which are incorporated by reference herein intheir respective entireties:

-   -   U.S. Pat. No. 4,785,180, titled OPTOELECTRIC SYSTEM HOUSED IN A        PLASTIC SPHERE, issued Nov. 15, 1988;    -   U.S. Pat. No. 6,804,012, titled ARRANGEMENT FOR THE DEFECTION OF        RELATIVE MOVEMENTS OR RELATIVE POSITION OF TWO OBJECTS, issued        Oct. 12, 2004;    -   European patent application Ser. No. 1,850,210, titled        OPTOELECTRONIC DEVICE FOR DE1ERMINING RELATIVE MOVEMENTS OR        RELATIVE POSITIONS OF TWO OBJECTS, published Oct. 31, 2007;    -   U.S. Patent Application Publication No. 2008/0001919, titled        USER INTERFACE DEVICE, published Jan. 3, 2008; and    -   U.S. Pat. No. 7,516,675, titled JOYSTICK SENSOR APPARATUS,        issued Apr. 14, 2009.

Referring again to the input control device 1000 in FIGS. 6-11, ajoystick 1008 extends from the central portion 1002. Forces exerted onthe central portion 1002 via the joystick 1008 define input motions forthe sensor arrangement 1048. For example, the sensor arrangement 1048(FIGS. 8 and 9) in the base 1004 can be configured to detect the inputforces and moments applied by a surgeon to the joystick 1008. Thejoystick 1008 can be spring-biased toward a central, or home, position,in which the joystick 1008 is aligned with the Z axis, a vertical axisthrough the joystick 1008, central portion 1002, and the space joint1006. Driving (e.g. pushing and/or pulling) the joystick 1008 away fromthe Z axis in any direction can be configured to “drive” an end effectorof an associated surgical tool in the corresponding direction. When theexternal driving force is removed, the joystick 1008 can be configuredto return to the central, or home, position and motion of the endeffector can be halted. For example, the central portion 1002 andjoystick 1008 can be spring-biased toward the home position.

In various instances, the space joint 1006 and the joystick 1008 coupledthereto define a six degree-of-freedom input control. Referring againnow to the end effector 1052 of the surgical tool 1050 in FIG. 12, theforces on the joystick 1008 of the input control device 1000 in the Xdirection correspond to displacement of the end effector 1052 along theX_(t) axis thereof (e.g. longitudinally), forces on the joystick 1008 inthe Y direction correspond to displacement of the end effector 1052along the Y_(t) axis thereof (e.g. laterally), and forces on thejoystick 1008 in the Z direction correspond to displacement of the endeffector 1052 along the Z_(t) axis (e.g. vertically/up and down).Additionally, forces on the joystick 1008 about the X axis (the momentforces R) result in rotation of the end effector 1052 about the X_(t)axis (e.g. a rolling motion about a longitudinal axis in the directionR_(t)), forces on the joystick 1008 about the Y axis (the moments forcesP) result in articulation of the end effector 1052 about the Y_(t) axis(e.g. a pitching motion in the direction P_(t)), and forces on thejoystick 1008 about the Z axis (the moment forces T) result inarticulation of the end effector 1052 about the Z_(t) axis of the endeffector (e.g. a yawing or twisting motion in the direction TO. In suchinstances, the input control device 1000 comprises a six-degree offreedom joystick, which is configured to receive and detect sixdegrees-of-freedom—forces along the X, Y, and Z axes and moments aboutthe X, Y, and Z axes. The forces can correspond to translational inputand the moments can correspond to rotational inputs for the end effector1052 of the associated surgical tool 1050. Six degree-of-freedom inputdevices are further described herein. Additional degrees of freedom(e.g. for actuating the jaws of an end effector or rolling the endeffector about a longitudinal axis) can be provided by additional jointssupported by the joystick 1008, as further described herein.

In various instances, the input control device 1000 includes a wrist orjoint 1010 that is offset from the space joint 1006. The wrist 1010 isoffset from the space joint 1006 by a shaft, or lever, 1012 extendingalong the shaft axis S that is parallel to the axis X in theconfiguration shown in FIG. 6. For example, the joystick 1008 can extendupright vertically from the central portion 1002 and the base 1004, andthe joystick 1008 can support the shaft 1012.

As further described herein, the space joint 1006 can define the inputcontrol motions for multiple degrees of freedom. For example, the spacejoint 1006 can define the input control motions for translation of thesurgical tool in three-dimensional space and articulation of thesurgical tool about at least one axis. Rolling motions can also becontrolled by inputs to the space joint 1006, as further describedherein. Moreover, the wrist 1010 can define input control motions for atleast one degree of freedom. For example, the wrist 1010 can define theinput control motions for the rolling motion of the end effector.Moreover, the wrist 1010 can support an end effector actuator 1020,which is further described herein, to apply open and closing motions tothe end effector.

In certain instances, the rolling, yawing, and pitching motions of theinput control device 1000 are translatable motions that definecorresponding input control motions for the related end effector. Invarious instances, the input control device 1000 can utilize adjustablescaling and/or gains such that the motion of the end effector isscalable in relationship to the control motions delivered at the wrist1010.

In one aspect, the input control device 1000 includes a plurality ofmechanical joints, which can be elastically-coupled components, sliders,journaled shafts, hinges, and/or rotary bearings, for example. Themechanical joints include a first joint 1040 (at the space joint 1006)intermediate the base 1004 and the central portion 1002, which allowsrotation and tilting of the central portion 1002 relative to the base1004, and a second joint 1044, which allows rotation of the wrist 1010relative to the joystick 1008. In various instances, six degrees offreedom of a robotic end effector (e.g. three-dimensional translationand rotation about three different axes) can be controlled by userinputs at only these two joints 1040, 1044, for example. With respect tomotion at the first joint 1040, the central portion 1002 can beconfigured to float relative to the base 1004 at elastic couplings, asfurther described herein. With respect to the second joint 1044, thewrist 1010 can be rotatably coupled to the shaft 1012, such that thewrist 1010 can rotate in the direction R (FIG. 6) about the shaft axisS. Rotation of the wrist 1010 relative to the shaft 1012 can correspondto a rolling motion of an end effector about a central tool axis, suchas the rolling of the end effector 1052 about the X_(t) axis. Rotationof the wrist 1010 by the surgeon to roll an end effector providescontrol of the rolling motion at the surgeon's fingertips andcorresponds to a first-person perspective control of the end effector(i.e. from the surgeon's perspective, being “positioned” at the jaws ofthe remotely-positioned end effector at the surgical site). As furtherdescribed herein, such placement and perspective can be utilized tosupply precision control motions to the input control device 1000 duringportions of a surgical procedure (e.g. a precision motion mode).

The various rotary joints of the input control device can include asensor arrangement configured to detect the rotary input controlsapplied thereto. The wrist 1010 can include a rotary sensor (e.g. thesensor 1049 in FIG. 25), which can be a rotary force/torque sensorand/or transducer, rotary strain gauge and/or strain gauge on a spring,rotary encoder, and/or an optical sensor to detect rotary displacementat the joint, for example.

In certain instances, the input control device 1000 can include one ormore additional joints and/or hinges for the application of rotationalinput motions corresponding to articulation of an end effector. Forexample, the input control device 1000 can include a hinge along theshaft 1012 and/or between the shaft 1012 and the joystick 1008. In oneinstance, hinged input motions at such a joint can be detected byanother sensor arrangement and converted to rotary input control motionsfor the end effector, such as a yawing or pitching articulation of theend effector. Such an arrangement requires one or more additional sensorarrangements and would increase the mechanical complexity of the inputcontrol device.

The input control device 1000 also includes the end effector actuator1020. The end effector actuator 1020 includes opposing fingers 1022extending from the wrist 1010 toward the joystick 1008 and the centralportion 1002 of the space joint 1006. The opposing fingers 1022 extenddistally beyond the space joint 1006. In such instances, the wrist 1010is proximal to the space joint 1006, and the distal ends 1024 of theopposing fingers 1022 are distal to the space joint 1006, which mirrorsthe jaws being positioned distal to the articulation joints of a robotictool, for example. Applying an actuation force to the opposing fingers1022 comprises an input control for a surgical tool. For example,referring again to FIG. 12, applying a pinching force to the opposingfingers 1022 can close and/or clamp the jaws 1054 of the end effector1052 (see arrows C in FIG. 12). In various instances, applying aspreading force can open and/or release the jaws 1054 of the endeffector 1052, such as for a spread dissection task, for example. Theend effector actuator 1020 can include at least one sensor for detectinginput control motions applied to the opposing fingers 1022. For example,the end effector actuator can include a displacement sensor and/or arotary encoder for detecting the input control motions applied to pivotthe opposing fingers 1022 relative to the shaft 1012.

In various instances, the end effector actuator 1020 can include one ormore loops 1030, which are dimensioned and positioned to receive asurgeon's digits. For example, referring primarily to FIGS. 10 and 11,the surgeon's thumb T is positioned through one of the loops 1030 andthe surgeon's middle finger M is positioned through the other loop 1030.In such instances, the surgeon can pinch and/or spread his thumb T andmiddle finger M to actuate the end effector actuator 1020. In otherinstances, the loops 1030 can be structured to receive more than onedigit and, depending on the placement of the loops 1030, differentdigits may engage the loops. In various instances, the finger loops 1030can facilitate spread dissection functions and/or translation of therobotic tool upward or downward (i.e. the application of a verticalforce at the space joint 1006, for example). In certain instances, theloops 1030 can define complete loops; however, in other instances,partial loops (e.g. half-circles) can be utilized In still otherinstances, the end effector actuator 1020 may not include the loops1030. For example, the end effector actuator 1020 can be spring-biasedoutwardly such that loops are not needed to draw the opposing fingers1022 apart, such as for spread dissection functions.

The opposing fingers 1022 of the end effector actuator 1020 define aline of symmetry that is aligned with the longitudinal shaft axis Salong which the shaft 1012 extends when the fingers 1022 are inunactuated positions. The line of symmetry is parallel to the axis Xthrough the multi-dimensional space joint 1006. Moreover, the centralaxis of the joystick 1008 is aligned with the line of symmetry. Invarious instances, the motion of the opposing fingers 1022 can beindependent. In other words, the opposing fingers 1022 can be displacedasymmetrically relative to the longitudinal shaft axis S during anactuation. The displacement of the opposing fingers 1022 can depend onthe force applied by the surgeon, for example. With certain surgicaltools, the jaws of the end effector can pivot about an articulation axissuch that various closed positions of the jaws are not longitudinallyaligned with the shaft of the surgical tool. Moreover, in certaininstances, it can be desirable to hold one jaw stationary, such asagainst fragile tissue and/or a critical structure, and to move theother jaw relative to the non-moving jaw. To accommodate such closuremotions, the range of motion of the opposing fingers 1022 on the inputcontrol device 1000 can be larger than the range of motion of the jawsof the end effector, for example. For example, referring to FIG. 12A,the surgical tool 1050′ is shown in an articulated configuration inwhich the jaws can be clamped together out of alignment with alongitudinal shaft axis of the surgical tool 1050′. In such instances,the jaws and, thus the fingers 1022 on the input control device 1000(FIGS. 6-11) would be actuated asymmetrically to move the jaws of theend effector 1052 to a closed configuration.

Referring now to FIGS. 13A-15B, various control motions applied to theend effector actuator 1020 and corresponding actuations of an endeffector 1062 are shown. The end effector 1062 includes opposing jaws1064 that are movable between an open configuration (FIG. 13A), anintermediate configuration (FIG. 14A), and a closed configuration (FIG.15A) as the opposing fingers 1022 of the end effector actuator 1020 movebetween an open configuration (FIG. 13B), an intermediate configuration(FIG. 14B), and a closed configuration (FIG. 15B), respectively.

The input control device 1000 also includes at least one additionalactuator, such as the actuation buttons 1026, 1028, for example, whichcan provide additional controls at the surgeon's fingertips. Forexample, the actuation buttons 1026, 1028 are positioned on the joystick1008 of the input control device 1000 such that the surgeon can accessthe buttons 1026, 1026 with a digit, such as an index finger I. Theactuation buttons 1026, 1028 can correspond to buttons for activatingthe surgical tool, such as firing, extending, activating, translating,and/or retracting a knife, energizing one or more electrodes, adjustingan energy modularity, affecting diagnostics, biopsy sampling, ablation,and/or other surgical tasks, for example. In other instances, theactuation buttons 1026, 1028 can provide inputs to an imaging system toadjust a view of the surgical tool, such as zooming in/out, panning,tracking, titling and/or rotating, for example. In certain instance theactuators can be positioned in different locations than the actuationbuttons 1026, 1028, such as positioned for use by a thumb or anotherdigit, for example. Additionally or alternatively, the actuators can beprovided on a touch screen and/or foot pedal, for example.

Referring primarily now to FIGS. 10 and 11, a user is configured toposition his or her hand relative to the input control device 1000 suchthat the wrist 1010 is proximal to the space joint 1006. Morespecifically, the user's palm is positioned adjacent to the wrist 1010and the user's fingers extend distally toward the joystick 1008 and thecentral portion 1002 of the space joint 1006. Distally-extending fingers1022 (for actuation of the jaws) and the actuation buttons 1026, 1028(for actuation of a surgical function at the jaws) are distal to thespace joint 1006 and wrist 1010. Such a configuration mirrors theconfiguration of a surgical tool in which the end effector is distal toa more-proximal articulation joint(s) and/or rotatable shaft and, thus,provides an intuitive arrangement that facilitates a surgeon's trainingand adoption of the input control device 1000.

In various instances, a clutch-less input control device including a sixdegree-of-freedom input control, an end effector actuator, andadditional actuation buttons can define alternative geometries to theinput control device 1000. Stated differently, a clutch-less inputcontrol device does not prescribe the specific form of the joystickassembly of the input control device 1000. Rather, a wide range ofinterfaces may be designed based on formative testing and userpreferences. In various instances, a robotic system can allow for usersto choose from a variety of different forms to select the style thatbest suits his/her needs. For example, a pincher, pistol, ball, pen,and/or a hybrid grip, among other input controls, can be supported.Alternative designs are further described herein and in variouscommonly-owned patent applications that have been incorporated byreference herein in their respective entireties.

In various instances, the input controls for the input control device1000 are segmented between first control motions and second controlmotions. For example, first control motions and/or parameters thereforcan be actuated in a first mode and second control motions and/orparameters therefor can be actuated in a second mode. The mode can bebased on a factor provided by the surgeon and/or the surgical robotcontrol system and/or detected during the surgical procedure. Forexample, the mode can depend on the proximity of the surgical tool totissue, such as the proximity of the surgical tool to the surface oftissue and/or to a critical structure. Various distance determiningsystems for determining proximity to one or more exposed and/or at leastpartially hidden critical structures are further described herein.

In one instance, referring now to FIG. 25, the input control device 1000can be communicatively coupled to a control circuit 832 of a controlsystem 833, which is further described herein. In the control system833, the control circuit 832 can receive input signals from the inputcontrol device 1000, such as feedback detected by the various sensorstherein and related to control inputs at the joystick 1008 and/or wrist1010 and/or outputs from the various sensors thereon (e.g. the sensorarrangement 1048 and/or the rotary sensor 1049 at the wrist 1010. Forexample, signals detected by the sensor arrangement 1048, i.e. themulti-axis force and torque sensor of the space joint 1006, can beprovided to the control circuit 832. Additionally, signals detected bythe sensor 1049, i.e., the rotary sensor of the wrist 1010, can beprovided to the control circuit 832. A memory 834 for the control system833 also includes control logic for implementing the input controlsprovided to the input control device 1000 and detected by the varioussensors (e.g. the sensors 1048 and 1049).

Referring now to FIG. 11A, control logic 1068 for the input controldevice 1000 can implement a first mode 1070 if the distance determinedby a distance determining subsystem is greater than or equal to acritical distance and can implement a second mode 1072 if the distancedetermined by the distance determining subsystem is less than thecritical distance. The control logic can be utilized in the controlcircuit 832, a control circuit 1400 (FIG. 11C), a combinational logicalcircuit 1410 (FIG. 11D), and/or a sequential logic circuit 1420 (FIG.11E), for example, where an input is provided from inputs to the inputcontrol device 1000 (FIGS. 6-11) and/or a surgical visualization systemor distance determining subsystem thereof, as further described herein.

For example, turning to FIG. 11C, the control circuit 1400 can beconfigured to control aspects of the input control device 1000,according to at least one aspect of this disclosure. The control circuit1400 can be configured to implement various processes described herein.The control circuit 1400 may comprise a microcontroller comprising oneor more processors 1402 (e.g., microprocessor, microcontroller) coupledto at least one memory circuit 1404. The memory circuit 1404 storesmachine-executable instructions that, when executed by the processor1402, cause the processor 1402 to execute machine instructions toimplement various processes described herein. The processor 1402 may beany one of a number of single-core or multicore processors known in theart. The memory circuit 1404 may comprise volatile and non-volatilestorage media. The processor 1402 may include an instruction processingunit 1406 and an arithmetic unit 1408. The instruction processing unit1406 may be configured to receive instructions from the memory circuit1404 of this disclosure.

FIG. 11D illustrates the combinational logic circuit 1410 that can beconfigured to control aspects of the input control device 1000,according to at least one aspect of this disclosure. The combinationallogic circuit 1410 can be configured to implement various processesdescribed herein. The combinational logic circuit 1410 may comprise afinite state machine comprising a combinational logic 1412 configured toreceive data associated with the input control device 1000 (FIGS. 6-11)and a surgical visualization system and/or distance determiningsubsystem thereof from an input 1414, process the data by thecombinational logic 1412, and provide an output 1416.

FIG. 11E illustrates a sequential logic circuit 1420 configured tocontrol aspects of the input control device 1000 (FIGS. 6-11), accordingto at least one aspect of this disclosure. For example, the sequentiallogic circuit 1420 or the combinational logic 1422 can be configured toimplement various processes described herein. The sequential logiccircuit 1420 may comprise a finite state machine. The sequential logiccircuit 1420 may comprise a combinational logic 1422, at least onememory circuit 1424, and a clock 1429, for example. The at least onememory circuit 1424 can store a current state of the finite statemachine. In certain instances, the sequential logic circuit 1420 may besynchronous or asynchronous. The combinational logic 1422 is configuredto receive data associated with the input control device 1000 (FIGS.6-11) and a surgical visualization system and/or distance determiningsubsystem thereof from an input 1426, process the data by thecombinational logic 1422, and provide an output 1428. In other aspects,the circuit may comprise a combination of a processor (e.g., processor1402 in FIG. 11C) and a finite state machine to implement variousprocesses herein. In other aspects, the finite state machine maycomprise a combination of a combinational logic circuit (e.g.,combinational logic circuit 1410 in FIG. 11D) and the sequential logiccircuit 1420. Control circuits similar to the control circuits 1400,1410, and 1420 can also be utilized to control various aspects of asurgical robot and/or surgical visualization system, as furtherdescribed herein.

In various instances, the input control device 1000 is configured tooperate in different modes, such as a gross mode and a precision mode,for example. The variation in control motions in the different modes canbe accomplished by selecting a preset scaling profile. For example,control motions with the multi-dimensional space joint 1006 can bescaled up for gross mode such that small forces on the space joint 1006result in significant displacements of the end effector. Moreover, thecontrol motions with the wrist 1010 can be scaled down for precisionmode such that large moments at the wrist 1010 result in fine rotationaldisplacements of the end effector. The preset scaling profile can beuser-selected and/or depend on the type and/or complexity of a surgicalprocedure and/or the experience of the surgeon, for example. Alternativeoperational modes and settings are also contemplated.

Referring again to FIG. 11A, in certain instances, the first mode1070can correspond to a gross control mode and the second mode 1072 cancorrespond to a precision control mode. One or more user inputs to thespace joint 1006 can correspond to control inputs to affect gross motionof the surgical tool in the first mode 1070, such as the largedisplacements of the surgical tool toward the surgical site. One or moreinputs to the wrist 1010 can define the rotational displacements of thesurgical tool, such as the rolling rotary displacement of the surgicalend effector at the surgical site. The segmented controls can beselectively locked out, such that rolling rotational inputs at the wrist1010 are disabled during portions of a surgical procedure and one ormore inputs at the space joint 1006 are disabled during other portionsof the surgical procedure. For example, it can be desirable to lock outthe rolling rotational inputs during the first mode 1070, such as whenthe surgical end effector is positioned outside a threshold proximityzone around a surgical site and/or critical structure. Moreover, invarious instances, the control motions for the space joint 1006 and/orthe wrist 1010 can be scaled up or down based on input from the distancedetermining system. The scaling parameters for the control motionsprovided to the space joint 1006 and the wrist 1010 can be different inthe first mode 1070 and the second mode 1072. For example, the velocityof the robotic tool can be slowed down during a precision motion modeand sped up during a gross motion mode.

Referring now to FIG. 11B, a table depicting scaling scenarios invarious operational modes is depicted. An input control device, such asthe input control device 1000 (FIGS. 6-11) can be configured to receiveat least six different inputs (e.g. Input A, Input B, etc.)corresponding to six degrees of freedom of a surgical tool coupledthereto. The inputs can be scaled based on the operational mode (e.g.the first mode 1070, the second mode 1072, etc.), which is determined byan input to the control circuit, such as proximity data from a distancedetermining subsystem of a surgical visualization system, for example. Afirst list of rules 1074 comprises first control parameters forcontrolling the surgical tool based on input from the input controldevice 1000. A second list of rules 1076 comprise second controlparameters for controlling the surgical tool based on input from theinput control device 1000. In certain instances, such as when an inputis “locked out”, the variable value in the list of rules 1074, 1076 canbe zero. Additional modes and additional rules/control parameters arecontemplated.

In various aspects, the gross motions described in the presentdisclosure are gross translational motions characterized by speedsselected from a range of about 3 inches/second to about 4 inches/second.In at least one example, a gross translational motion, in accordancewith the present disclosure, is about 3.5 inches/second. In variousaspects, by contrast, the fine motions described in the presentdisclosure can be fine translational motions characterized by speedsless than or equal to 1.5 inch/second. In various aspects, the finemotions described in the present disclosure can be fine translationalmotions characterized by speeds selected from a range of about 0.5inches/second to about 2.5 inches/second.

In various aspects, the gross motions described in the presentdisclosure are gross rotational motions characterized by speeds selectedfrom a range of about 10 radians/second to about 14 radians/second. Inat least one example, a gross rotational motion, in accordance with thepresent disclosure, is about 12.6 radians/second. In various aspects, bycontrast, the fine motions described in the present disclosure can befine rotational motions characterized by speeds selected from a range ofabout 2 radians/second to about 4 radians/second. In at least oneexample, a fine rotational motion, in accordance with the presentdisclosure, is about 2.3 radians/second.

In various aspects, the gross motions of the present disclosure are twoto six times greater than the fine motions. In various aspects, thegross motions of the present disclosure are three to five times greaterthan the fine motions.

As described herein, the space joint 1006 can define input controlmotions for six degrees of freedom. For example, the space joint 1006can define the input control motions for non-rotational translation ofthe surgical tool in three-dimensional space and rotation of thesurgical tool about three different axes. In such instances, thejoystick 1008 is configured to receive inputs in three-dimensional spaceand about three axes of rotation. Moreover, the end effector actuator1020 (e.g. a jaw closure mechanism) is built into a sixdegree-of-freedom joystick assembly comprising the joystick 1008 andassociated sensors in the base 1004. The input control motions from thespace joint 1006 can be selectively locked out and/or scaled duringdifferent portions of a surgical procedure.

An exemplary six-degree of freedom input control device 1100 is depictedin FIGS. 18-22. In various instances, such an input device can beincorporated into a user input device for a surgical robot, such as theinput control device 1000 (FIGS. 6-11), for example. The input controldevice 1100 includes a frame or base 1101, which typically remainsstationary on a surface such as a desk or table during use, and a cap1102, which is movably mounted on the base 1101 and forms the inputmechanism by which a user may input movements that are detected andinterpreted by the input control device 1100. In particular, the cap1102 of the input control device 1100 is designed to be grasped by theuser and manipulated relative to the base 1101 to generate the desiredinput. To determine the relative movements or positions of the cap 1102and base 1101, the input control device 1100 includes a first boardmember 1110 fixed relative to the base 1101 of the input control device1100, a second board member 1120 resiliently mounted in spaced relationto the first board member 1110 and adapted for movement or displacementrelative thereto, and a plurality of optoelectronic measuring cells 1118for determining relative movements or displacements between the firstand second board members 1110, 1120. The second board member 1120 iselastically connected to the first board 1110 by a plurality ofequally-spaced coil spring elements 1106.

Each of the measuring cells 1118 for determining the relative movementsand/or positions of the first and second boards 1110, 1120 comprises alight emitting element in the form of an infrared light-emitting diode(ILED) 1113 (FIGS. 18 and 19) projecting from on an upper side the firstboard 1110 and a position-sensitive infrared detector (PSID) 1123 (FIG.20) mounted on an underside of the second board 1120 and facing thefirst board 1110. Furthermore, a light shield housing 1130 is providedbetween the first board 1110 and the second board 1120 for effectivelyhousing the ILEDs 1113 and for shielding the PSIDs 1123 from anyunwanted or extraneous light that might otherwise affect the accuracy ofthe readings the PSIDs 1123 provide.

The light shield housing 1130 has a generally hollow structure with anumber of cavities 1131 defined therein that form individual light-pathchannels between each ILED 1113 on the first board 1110 and itsrespective PSID 1123 mounted on the second board 1120. Furthermore, asshown in FIG. 19, the light shield housing 1130 includes slit diaphragms1132 formed in a top wall 1133 thereof such that each of the slitdiaphragms 1132 is arranged in the light-path between an ILED 1113 andthe respective PSID 1123 that the ILED 1113 is intended to illuminate.

The light shield housing 1130 is thus configured to define a pluralityof light beam paths between the ILEDs 1113 on the first board 1110 andthe PSIDs 1123 on the second board 1120, such that each of the lightbeam paths is arranged to extend at an angle in the range of about 30°to about 60° (and preferably at about 45°) relative to the plane of thefirst board 1110, i.e. relative to a base reference plane for the inputcontrol device 1100. Furthermore, the light beam paths which are definedby the light-path channels 1131 formed along each side of the lightshield housing 1130 thereby extend in three separate, intersectingplanes corresponding to the planes of the housing sides. That is, thelight beam paths of the two measuring cells 1118 having a common PSID1123 may be considered to lie within the same plane. The light shieldhousing 1130 is thereby designed to form a three-dimensional array oflight beam paths between the ILEDs 1113 and the PSIDs 1123. This, inturn, provides for a particularly compact optoelectronic device 1100,while also affording great flexibility in modifications to the shape ofthe light shield housing 1130.

With further reference to FIG. 20, because each of the PSIDs 1123 isilluminated by two separate ILEDs 1113, each of the sides of thegenerally three-sided light shield housing 1130 is divided into twoseparate light-path channels 1131 by a central dividing wall 1114. Inthis way, each PSID 1123 is illuminated by its two separate ILEDs 1113via two separate slit diaphragms 1132. Each of the slits 1132 providesoptical communication with the associated PSID for only one of the ILEDs1113. That is, each ILED 1113 is provided with its own dedicated slitdiaphragm 1132. The slit diaphragms 1132 of each pair are arrangedsubstantially parallel and extend generally perpendicular to alight-sensitive part of the associated PSID 1123.

Referring primarily to FIG. 18, the optoelectronic device 1100 furtherincludes a stop arrangement 1140, which is designed to provide aphysical barrier to movement or displacement of the second board 1120relative to the first board 1110 beyond a specific predetermined limit.The stop arrangement 1140 thereby prevents any inadvertent overloadingof the input control device 1100 during use. The stop arrangement 1140includes a plate-like connecting member 1142 and pin member 1141.

Openings or holes 1124 formed through the second board 1120 have adiameter substantially larger than the diameter of the pin members 1141they receive. In the neutral position of the second board 1120 relativeto the first board 1110, each of the pin members 1141 can be positionedsubstantially centrally in its respective hole 1124 through the secondboard 1120. By virtue of the resilient deformability of the three coilspring elements 1106 connecting the board members 1110, 1120, the secondboard 1120 is able to move laterally and rotationally in a planeparallel to the first board 1110 within the limits defined by the holes1124 and the sides of the pin members 1141. As shown in FIG. 21, as thesecond board 1120 is rotated counterclockwise from its neutral positionrelative to the first board 1110 against the bias of the coil springelements 1106, the edges of the holes 1124 eventually engage the lateralsides of the pin members 1141, which in turn act as a stop and preventfurther rotation of the second board 1120. The same effect naturallyalso occurs for clockwise rotations or lateral translations of thesecond board 1120. In various instances, elastomeric elements 1107 inthe form of foam blocks, for example, can form a cushion for the pinmembers 1141 of the stop arrangement 1140.

With particular reference to FIG. 22, when a tilting (i.e. rotational)movement is applied to the second board 1120 (via the cap 1102) asshown, the second board 1120 will deflect until, after a predeterminedamount of tilting has occurred, the second board 1120 engages theplate-like connecting member 1142 in an angled peripheral region 1143.The contact or engagement with the angled peripheral region 1143 of thefixed plate-like connecting member 1142 acts to stop further relativemovement of the second board 1120 in that direction. Simultaneously, oreven alternatively, an upper inside surface of the cap 1102 may engage acorresponding angled peripheral region 1143 of the plate-like connectingmember 1142 as indicated in FIG. 22. The first board 1110, the lightshield housing 1130 and the stop arrangement 1140 can all remainstationary relative to the frame of the input control device 1100, whilethe cap 1102 and the second board 1120 are moved relative thereto duringoperation of the device. The input control device 1100 as well asvarious alternative designs and/or features thereof are furtherdescribed in European patent application Ser. No. 1,850,210, titledOPTOELECTRONIC DEVICE FOR DETERMINING RELATIVE MOVEMENTS OR RELATIVEPOSITIONS OF TWO OBJECTS, published Oct. 31, 2007, which is incorporatedby reference herein in its entirety.

Certain input control devices, such as the input devices at thesurgeon's console 116 in FIGS. 1 and 2 can be bulky and require a largefootprint within an operating room. Additionally, the surgeon can berequired to stay in a predefined location (e.g. sitting at the surgeon'sconsole 116) as long as the surgeon remains actively involved in thesurgical procedure. Additionally, the ergonomics of the input controldevices may be less than desirable for many surgeons and can bedifficult to adjust and/or customize, which can take a toll on thehealth and longevity of the surgeon's career and/or lead to fatiguewithin a surgical case.

A compact input control device, which requires a smaller footprint, canbe incorporated into an adjustable workspace rather than the surgeon'sconsole 116. The adjustable workspace can allow a range of positioningof the input control device. In various instances, one or more compactinput control devices can be positioned and/or moved around theoperating room, such as near a patient table and/or within a sterilefield, such that the surgeon can select a preferred position forcontrolling the robotic surgical procedure without being confined to apredefined location at a bulky surgeon's console. Moreover, theadaptability of the compact input control device can allow the inputcontrol device to be positioned at an adjustable workspace.

For example, referring now to FIGS. 16-17A, the input control device1000 is incorporated into an adjustable workspace 1080 for a surgeon.The adjustable workspace 1080 includes a surface or desk 1082 and amonitor 1088 for viewing the surgical procedure via the endoscope. Thedesk 1082 and/or the monitor 1088 can be repositioned at differentheights. In various instances, a first height can be selected such thatthe surgeon can stand at the desk 1082 and, at a different time, asecond height can be selected such that the surgeon can sit at the desk1082. Additionally or alternatively, the sitting and standing heightscan be adjusted for different surgeons. Moreover, the desk 1082 can bemoved relative to the monitor 1088 and the monitor 1088 can be movedrelative to the desk 1082. For example, the desk 1082 and/or the monitor1088 can be supported on releasably lockable wheels or casters.Similarly, a chair can be moved relative to the desk 1082 and themonitor 1088. In such instances, the X, Y, and Z positions of thevarious components of the adjustable workspace 1080 can be customized bythe surgeon.

The desk 1082 includes a foot pedal board 1086; however, in otherinstances, a foot pedal board 1086 may not be incorporated into the desk1082. In certain instances, the foot pedal board 1086 can be separatefrom the desk 1082, such that the position of the foot pedal board 1086relative to the desk 1082 and/or chair can be adjustable as well.

In various instances, the adjustable workspace 1080 can be modular andmoved toward the patient table or bedside. In such instances, theadjustable workspace 1080 can be draped with a sterile barrier andpositioned within the sterile field. The adjustable workspace 1080 canhouse and/or support the processors and/or computers for implementingthe teleoperation of the surgical robot from inputs to the input controldevice 1000 at the adjustable workspace 1080. Moreover, the desk 1082includes a platform or surface 1084 that is suitable for supporting thearm(s)/wrist(s) of the surgeon with limited mechanical adjustmentsthereto.

Owing to the smaller size and reduced range of motion of the inputcontrol device 1000, as well as the adjustability of the workspace 1080,the surgeon's console can define a low profile and require a smallerfootprint in the operating room. Smaller consoles can provide more spacein the operating room. Additionally, the smaller footprint can allowmultiple users (e.g. an experienced surgeon and less experienced surgeonor trainee, such as a medical student or resident) to cooperativelyperform a surgical procedure in close proximity, which can facilitatetraining. The small input control devices can be utilized in astimulator or real system, for example, and can be remote to thesurgical theater and/or at the robotic surgical system.

Referring primarily to FIGS. 16 and 17A, the adjustable workspace 1080also supports additional axillary devices. For example, a keyboard 1090and a touchpad 1092 are supported on the surface 1084 of the desk 1082.Alternative axillary devices are also contemplated, such as atraditional computer mouse and other imaging and diagnostic equipmentsuch as registered magnetic resonance imaging (MRI) or computerizedtomography (CT) scan data, images, and medical histories, for example.The axillary devices can control the graphical user interface on themonitor 1088, and the input control devices 1000 can control theteleoperation of the surgical robot. In such instances, the two distinctcontrol inputs allow the surgeon to control teleoperation functionsusing the clutch-less, input control device(s) 1000 while engaging withthe graphical user interface on the monitor 1088 with more conventionaltechniques. As a result, the user can interact with applications on themonitor 1088 concurrently with the teleoperation of the surgical robot.Moreover, the dual, segregated control input creates a clear cognitivedistinction between the teleoperation environment and the graphical userinterface environment.

In various instances, an adjustable workspace for the surgeon can bedesired. For example, the surgeon may want to be free and/or untetheredand/or unconfined to a predefined location at the surgeon's console, asfurther described herein. In certain instances, a surgeon may want torelocate during a surgical procedure. For example, a surgeon may want to“scrub in” quickly during a surgical procedure and enter the sterilefield in order to view the surgical procedure and/or the patientin-person, rather than on a video monitor. Moreover, a surgeon may notwant to give up control of the surgical robot as the surgeon relocates.

A mobile input control device can allow the surgeon to relocate and evenenter the sterile field during a surgical procedure. The mobile inputcontrol device can be modular, for example, and compatible withdifferent docking stations within an operating room. In variousinstances, the mobile portion of the input control device can be asingle-use device, which can be sterilized for use within the sterilefield.

As an example, referring now to FIG. 23, an input control device 1200 isshown. The input control device 1200 includes a base 1204, which issimilar to the base 1004 of the input control device 1000 in manyrespects. The input control device 1200 can include a multi-axis forceand torque sensor 1203, as described herein, which is configured todetect forces and moments applied to the base 1204 by a modular joystickcomponent 1208, which is similar to the joystick 1008 in many respects.The modular joystick component 1208 can be releasably docked in the base1204 to apply forces for detection by the sensor 1203 housed therein. Ashaft 1212, which is similar to the shaft 1012 in many respects, extendsfrom the joystick 1208 and supports at least one movable finger 1222,which is similar to the fingers 1022 in many respects Similar to theinput control device 1000, the input control device 1200 can alsoinclude a wrist rotatably coupled to the modular joystick component1208, which can be rotated to supply control motions such as a rollingcontrol motion for a surgical end effector. For example, the shaft 1212can include a wrist component at a proximal end 1225 thereof.

In operation, the input control device 1200 can be engaged by the handof a surgeon. Forces applied by the surgeon's hand are detected andcorresponding signals are conveyed to a control unit for controlling arobotic surgical tool in signal communication with the input controldevice 1200. In such instances, forces applied in the X, Y, and Zdirections can correspond to translation of the end effector of thesurgical tool in the X, Y, and Z directions, and moments about the X, Y,and Z axes can correspond to rotation of the end effector about the X,Y, and Z axes. In various instances, controls by the input controldevice 1200 can be segmented based on the detected input and/or positionof the end effector at the surgical site (e.g. proximity to ananatomical and/or critical structure).

The input control device 1200 includes separable components includingthe base 1204, which is separable from the modular joystick component1208. In certain instances, the modular joystick component 1208 can nestand/or fit within an opening 1205 in the base 1204. In variousinstances, the joystick 1208 and the base 1204 can mechanically andelectrically couple. In various instances, the opening 1205 in the base1204 can include a registration key, which allows the joystick component1208 to be received within the opening 1205 at a set angularorientation, such that the position of the modular joystick component1208 relative to the base 1204 is known.

In various instances, the modular joystick component 1208 and the base1204 can include communication modules that enable communicationtherebetween. Because the communication does not require high poweredsignals, near-field communication protocols can be utilized in variousinstances. A sterile barrier 1230 can extend between the modularcomponents of the input control device 1200. The sterile barrier 1230 isa thin and flexible sheet positioned between the modular components, forexample. Near-field communication signals can travel through such alayer of material. The sterile barrier 1230 can define a drape or sheetthat covers the base 1204, for example. In one aspect, the drape caninclude a thin element of plastic or elastomeric material forpositioning, location, and transference of forces.

In certain instances, the base 1204 can be positioned in the sterilefield during a surgical procedure. For example, the base 1204 can bemounted onto a bedrail 1232 and/or table adjacent to the patient. Incertain instances, the base 1204 can be a reusable or multi-usecomponent of the input control device 1200. A plurality of bases 1204can be positioned around a surgical theater, such as a remote surgeon'sconsole outside the sterile field and on the patient table within thesterile field, among other locations, for example.

The joystick component 1208 can be compatible with each base 1204. Invarious instances, the joystick component 1208 can be a disposableand/or single-use component. In other instances, the joystick component1208 can be re-sterilized between uses. For example, the joystickcomponent 1208 can be sterilized (e.g. low-temperature sterilization)and sealed prior to use. When the surgeon moves into the sterile fieldduring a surgical procedure, the sealed joystick component 1208 can beunsealed and ready to use. After the use, the joystick component 1208can be disposed and/or sterilized for a subsequent use.

Visualization Systems

“Digital surgery” can embrace robotic systems, advanced imaging,advanced instrumentation, artificial intelligence, machine learning,data analytics for performance tracking and benchmarking, connectivityboth inside and outside of the operating room (OR), and more. Althoughvarious surgical platforms described herein can be used in combinationwith a robotic surgical system, such surgical platforms are not limitedto use with a robotic surgical system. In certain instances, advancedsurgical visualization can occur without robotics, without thetelemanipulation of robotic tools, and/or with limited and/or optionalrobotic assistance. Similarly, digital surgery can occur withoutrobotics, without the telemanipulation of robotic tools, and/or withlimited and/or optional robotic assistance.

In one instance, a surgical visualization system can include a firstlight emitter configured to emit a plurality of spectral waves, a secondlight emitter configured to emit a light pattern, and one or morereceivers, or sensors, configured to detect visible light, molecularresponses to the spectral waves (spectral imaging), and/or the lightpattern. The surgical visualization system can also include an imagingsystem and a control circuit in signal communication with thereceiver(s) and the imaging system. Based on output from thereceiver(s), the control circuit can determine a geometric surface map,i.e. three-dimensional surface topography, of the visible surfaces atthe surgical site and one or more distances with respect to the surgicalsite. In certain instances, the control circuit can determine one moredistances to an at least partially concealed structure. Moreover, theimaging system can convey the geometric surface map and the one or moredistances to a clinician. In such instances, an augmented view of thesurgical site provided to the clinician can provide a representation ofthe at least partially concealed structure within the relevant contextof the surgical site. For example, the imaging system can virtuallyaugment the concealed structure on the geometric surface map of theconcealing and/or obstructing tissue similar to a line drawn on theground to indicate a utility line below the surface. Additionally oralternatively, the imaging system can convey the proximity of one ormore surgical tools to the visible and obstructing tissue and/or to theat least partially concealed structure and/or the depth of the concealedstructure below the visible surface of the obstructing tissue. Forexample, the visualization system can determine a distance with respectto an augmented line on the surface of the visible tissue and convey thedistance to the imaging system. In various instances, the surgicalvisualization system can gather data and convey informationintraoperatively.

FIG. 24 depicts a surgical visualization system 500 according to atleast one aspect of the present disclosure. The surgical visualizationsystem 500 may be incorporated into a robotic surgical system, such as arobotic system 510. The robotic system 510 can be similar to the roboticsystem 110 (FIG. 1) and the robotic system 150 (FIG. 3) in manyrespects. Alternative robotic systems are also contemplated. The roboticsystem 510 includes at least one robotic arm, such as the first roboticarm 512 and the second robotic arm 514. The robotic arms 512, 514include rigid structural members and joints, which can includeservomotor controls. The first robotic arm 512 is configured to maneuvera surgical device 502, and the second robotic arm 514 is configured tomaneuver the imaging device 520. A robotic control unit can beconfigured to issue control motions to the robotic arms 512, 514, whichcan affect the surgical device 502 and an imaging device 520, forexample. The surgical visualization system 500 can create a visualrepresentation of various structures within an anatomical field. Thesurgical visualization system 500 can be used for clinical analysisand/or medical intervention, for example. In certain instances, thesurgical visualization system 500 can be used intraoperatively toprovide real-time, or near real-time, information to the clinicianregarding proximity data, dimensions, and/or distances during a surgicalprocedure.

In certain instances, a surgical visualization system is configured forintraoperative, real-time identification of one or more criticalstructures, such as critical structures 501 a, 50 lb in FIG. 24 and/orto facilitate the avoidance of the critical structure(s) 501 a, 501 b bya surgical device. In other instances, critical structures can beidentified preoperatively. In this example, the critical structure 501 ais a ureter and the critical structure 501 b is a vessel in tissue 503,which is an organ, i e the uterus. Alternative critical structures arecontemplated and numerous examples are provided herein. By identifyingthe critical structure(s) 501 a, 501 b, a clinician can avoidmaneuvering a surgical device too close to the critical structure(s) 501a, 501 b and/or into a region of predefined proximity to the criticalstructure(s) 501 a, 501 b during a surgical procedure. The clinician canavoid dissection of and/or near a vein, artery, nerve, and/or vessel,for example, identified as the critical structure, for example. Invarious instances, the critical structures can be determined on aprocedure-by-procedure basis. The critical structures can be patientspecific.

Critical structures can be structures of interest. For example, criticalstructures can include anatomical structures such as a ureter, an arterysuch as a superior mesenteric artery, a vein such as a portal vein, anerve such as a phrenic nerve, and/or a tumor, among other anatomicalstructures. In other instances, a critical structure can be a foreignstructure in the anatomical field, such as a surgical device, surgicalfastener, clip, tack, bougie, band, and/or plate, for example. Criticalstructures can be determined on a patient-by-patient and/or aprocedure-by-procedure basis. Example critical structures are furtherdescribed herein and in U.S. patent application Ser. No. 16/128,192,titled VISUALIZATION OF SURGICAL DEVICES, filed Sep. 11, 2018, which isincorporated by reference herein in its entirety.

Referring again to FIG. 24, the critical structures 501 a, 501 b may beembedded in tissue 503. Stated differently, the critical structures 501a, 501 b may be positioned below the surface 505 of the tissue 503. Insuch instances, the tissue 503 conceals the critical structures 501 a,501 b from the clinician's view. The critical structures 501 a, 501 bare also obscured from the view of the imaging device 520 by the tissue503. The tissue 503 can be fat, connective tissue, adhesions, and/ororgans, for example. In various instances, the critical structures 501a, 501 can be partially obscured from view.

FIG. 24 also depicts the surgical device 502. The surgical device 502includes an end effector having opposing jaws extending from the distalend of the shaft of the surgical device 502. The surgical device 502 canbe any suitable surgical device such as, for example, a dissector, astapler, a grasper, a clip applier, and/or an energy device includingmono-polar probes, bi-polar probes, ablation probes, and/or anultrasonic end effector. Additionally or alternatively, the surgicaldevice 502 can include another imaging or diagnostic modality, such asan ultrasound device, for example. In one aspect of the presentdisclosure, the surgical visualization system 500 can be configured toachieve identification of one or more critical structures and theproximity of the surgical device 502 to the critical structure(s).

The surgical visualization system 500 includes an imaging subsystem thatincludes an imaging device 520, such as a camera, for example,configured to provide real-time views of the surgical site. The imagingdevice 520 can include a camera or imaging sensor that is configured todetect visible light, spectral light waves (visible or invisible),and/or a structured light pattern (visible or invisible), for example.In various aspects of the present disclosure, the imaging system caninclude an imaging device such as an endoscope, for example.Additionally or alternatively, the imaging system can include an imagingdevice such as an arthroscope, angioscope, bronchoscope,choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope,esophagogastro-duodenoscope (gastroscope), laryngoscope,nasopharyngo-neproscope, sigmoidoscope, thoracoscope, ureteroscope, orexoscope, for example. In other instances, such as in open surgeryapplications, the imaging system may not include a scope.

The imaging device 520 of the surgical visualization system 500 can beconfigured to emit and detect light at various wavelengths, such as, forexample, visible light, spectral light wavelengths (visible orinvisible), and a structured light pattern (visible or invisible). Theimaging device 520 may include a plurality of lenses, sensors, and/orreceivers for detecting the different signals. For example, the imagingdevice 520 can be a hyperspectral, multispectral, or selective spectralcamera, as further described herein. The imaging device 520 can alsoinclude a waveform sensor 522 (such as a spectral image sensor,detector, and/or three-dimensional camera lens). For example, theimaging device 520 can include a right-side lens and a left-side lensused together to record two two-dimensional images at the same time and,thus, generate a three-dimensional image of the surgical site, render athree-dimensional image of the surgical site, and/or determine one ormore distances at the surgical site. Additionally or alternatively, theimaging device 520 can be configured to receive images indicative of thetopography of the visible tissue and the identification and position ofhidden critical structures, as further described herein. For example,the field of view of the imaging device 520 can overlap with a patternof light (structured light) formed by light arrays 530 projected on thesurface 505 of the tissue 503, as shown in FIG. 24.

Views from the imaging device 520 can be provided to a clinician and, invarious aspects of the present disclosure, can be augmented withadditional information based on the tissue identification, landscapemapping, and the distance sensor system 504. In such instances, thesurgical visualization system 500 includes a plurality of subsystems—animaging subsystem, a surface mapping subsystem, a tissue identificationsubsystem, and/or a distance determining subsystem, as further describedherein. These subsystems can cooperate to intraoperatively provideadvanced data synthesis and integrated information to the clinician(s)and/or to a control unit. For example, information from one or more ofthese subsystems can inform a decision-making process of a clinicianand/or a control unit for an input control device of the robotic system.

The surgical visualization system 500 can include one or more subsystemsfor determining the three-dimensional topography, or surface maps, ofvarious structures within the anatomical field, such as the surface oftissue. Exemplary surface mapping systems include Lidar (light radar),Structured Light (SL), three-dimensional (3D) stereoscopy (stereo),Deformable-Shape-from-Motion (DSfM), Shape-from-Shading (SfS),Simultaneous Localization and Mapping (SLAM), and Time-of-Flight (ToF).Various surface mapping systems are further described herein and in L.Maier-Hein et al., “Optical techniques for 3D surface reconstruction incomputer-assisted laparoscopic surgery”, Medical Image Analysis 17(2013) 974-996, which is incorporated by reference herein in itsentirety and is available at www.sciencedirect.com/science (lastaccessed Jan. 8, 2019). The surgical visualization system 500 can alsodetermine proximity to various structures within the anatomical field,including the surface of tissue, as further described herein.

In various aspect of the present disclosure, the surface mappingsubsystem can be achieved with a light pattern system, as furtherdescribed herein. The use of a light pattern (or structured light) forsurface mapping is known. Known surface mapping techniques can beutilized in the surgical visualization systems described herein.

Structured light is the process of projecting a known pattern (often agrid or horizontal bars) on to a surface. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, disclose a surgical system comprising a light source and aprojector for projecting a light pattern. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, are incorporated by reference herein in their respectiveentireties.

FIG. 37 illustrates a structured (or patterned) light system 700,according to at least one aspect of the present disclosure. As describedherein, structured light in the form of stripes or lines, for example,can be projected from a light source and/or projector 706 onto thesurface 705 of targeted anatomy to identify the shape and contours ofthe surface 705. A camera 720, which can be similar in various respectsto the imaging device 520 (FIG. 24), for example, can be configured todetect the projected pattern of light on the surface 705. The way thatthe projected pattern deforms upon striking the surface 705 allowsvision systems to calculate the depth and surface information of thetargeted anatomy.

In certain instances, invisible (or imperceptible) structured light canbe utilized The structured light can be used without interfering withother computer vision tasks for which the projected pattern may beconfusing. For example, the frames with the light pattern can beisolated from the frames that are shown (e.g. augmented out). In stillother instances, infrared light or extremely fast frame rates of visiblelight that alternate between two exact opposite patterns can be utilizedto prevent interference. Structured light is further described aten.wikipedia.org/wiki/Structured_light.

Referring again to FIG. 24, in one aspect, the surgical visualizationsystem 500 includes an emitter 506, which is configured to emit apattern of light, such as stripes, grid lines, and/or dots, to enablethe determination of the topography or landscape of the surface 505 ofthe tissue 503. For example, projected light arrays 530 can be used forthree-dimensional scanning and registration on the surface 505 of thetissue 503. The projected light arrays 530 can be emitted from theemitter 506 located on the surgical device 502 and/or the robotic arm512, 514 and/or the imaging device 520, for example. In one aspect, theprojected light array 530 is employed to determine the shape defined bythe surface 505 of the tissue 503 and/or the motion of the surface 505intraoperatively. The imaging device 520 is configured to detect theprojected light arrays 530 reflected from the surface 505 to determinethe topography of the surface 505 and various distances with respect tothe surface 505. One or more additional and/or alternative surfacemapping techniques may also be employed.

In various aspects of the present disclosure, a tissue identificationsubsystem can be achieved with a spectral imaging system. The spectralimaging system can rely on hyperspectral imaging, multispectral imaging,or selective spectral imaging, for example. Hyperspectral imaging oftissue is further described in U.S. Pat. No. 9,274,047, titled METHODSAND APPARATUS FOR IMAGING OF OCCLUDED OBJECTS, issued Mar. 1, 2016,which is incorporated by reference herein in its entirety.

In various instances, the imaging device 520 is a spectral camera (e.g.a hyperspectral camera, multispectral camera, or selective spectralcamera), which is configured to detect reflected spectral waveforms andgenerate a spectral cube of images based on the molecular response tothe different wavelengths. Spectral imaging is further described herein.

In various instances, hyperspectral imaging technology, can be employedto identify signatures in anatomical structures in order todifferentiate a critical structure from obscurants. Hyperspectralimaging technology may provide a visualization system that can provide away to identify critical structures such as ureters and/or bloodvessels, for example, especially when those structures are obscured byfat, connective tissue, blood, or other organs, for example. The use ofthe difference in reflectance of different wavelengths in the infrared(IR) spectrum may be employed to determine the presence of keystructures versus obscurants. Referring now to FIGS. 38-40, illustrativehyperspectral signatures for a ureter, an artery, and nerve tissue withrespect to obscurants such as fat, lung tissue, and blood, for example,are depicted.

FIG. 38 is a graphical representation 950 of an illustrative uretersignature versus obscurants. The plots represent reflectance as afunction of wavelength (nm) for wavelengths for fat, lung tissue, blood,and a ureter. FIG. 39 is a graphical representation 952 of anillustrative artery signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a vessel. FIG. 40 is a graphical representation 954 of anillustrative nerve signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a nerve.

Referring again to FIG. 24, the imaging device 520 may include anoptical waveform emitter 523 that is configured to emit electromagneticradiation 524 (NIR photons) that can penetrate the surface 505 of thetissue 503 and reach the critical structures 501 a, 501 b. The imagingdevice 520 and the optical waveform emitter 523 thereon can bepositionable by the robotic arm 512, 514. A corresponding waveformsensor 522 (an image sensor, spectrometer, or vibrational sensor, forexample) on the imaging device 520 is configured to detect the effect ofthe electromagnetic radiation 524 received by the waveform sensor 522.The wavelengths of the electromagnetic radiation 524 emitted by theoptical waveform emitter 523 can be configured to enable theidentification of the type of anatomical and/or physical structure, suchas the critical structures 501 a, 501 b. In one aspect, the wavelengthsof the electromagnetic radiation 524 may be variable. The waveformsensor 522 and optical waveform emitter 523 may be inclusive of amultispectral imaging system and/or a selective spectral imaging system,for example.

The identification of the critical structures 501 a, 501 b can beaccomplished through spectral analysis, photo-acoustics, and/orultrasound, for example. In certain instances, the waveform sensor 522and optical waveform emitter 523 may be inclusive of a photoacousticimaging system, for example. In various instances, the optical waveformemitter 523 can be positioned on a separate surgical device from theimaging device 520. Alternative tissue identification techniques arealso contemplated. In certain instances, the surgical visualizationsystem 500 may not be configured to identify hidden critical structures.

In one instance, the surgical visualization system 500 incorporatestissue identification and geometric surface mapping in combination witha distance determining subsystems, such as the distance sensor system504. The distance sensor system 504 is configured to determine one ormore distances at the surgical site. The distance sensor system 504 is atime-of-flight system that is configured to determine the distance toone or more anatomical structures. Alternative distance determiningsubsystems are also contemplated. In combination, the tissueidentification systems, geometric surface mapping, and the distancedetermining subsystem can determine a position of the criticalstructures 501 a, 50 lb within the anatomical field and/or the proximityof a surgical device 502 to the surface 505 of the visible tissue 503and/or to the critical structures 501 a, 501 b.

In various aspects of the present disclosure, the distance determiningsystem can be incorporated into the surface mapping system. For example,structured light can be utilized to generate a three-dimensional virtualmodel of the visible surface and determine various distances withrespect to the visible surface. In other instances, a time-of-flightemitter can be separate from the structured light emitter.

In various instances, the distance determining subsystem can rely ontime-of-flight measurements to determine one or more distances to theidentified tissue (or other structures) at the surgical site. In oneaspect, the distance sensor system 504 may be a time-of-flight distancesensor system that includes an emitter, such as the emitter 506, and areceiver 508, which can be positioned on the surgical device 502. In onegeneral aspect, the emitter 506 of the distance sensor system 504 mayinclude a very tiny laser source and the receiver 508 of the distancesensor system 504 may include a matching sensor. The distance sensorsystem 504 can detect the “time of flight,” or how long the laser lightemitted by the emitter 506 has taken to bounce back to the sensorportion of the receiver 508. Use of a very narrow light source in theemitter 506 can enable the distance sensor system 504 to determine thedistance to the surface 505 of the tissue 503 directly in front of thedistance sensor system 504.

Referring still to FIG. 24, d_(e) is the emitter-to-tissue distance fromthe emitter 506 to the surface 505 of the tissue 503 and d_(t) is thedevice-to-tissue distance from the distal end of the surgical device 502to the surface 505 of the tissue. The distance sensor system 504 can beemployed to determine the emitter-to-tissue distance d_(e). Thedevice-to-tissue distance d_(t) is obtainable from the known position ofthe emitter 506 on the shaft of the surgical device 502 relative to thedistal end of the surgical device 502. In other words, when the distancebetween the emitter 506 and the distal end of the surgical device 502 isknown, the device-to-tissue distance d_(t) can be determined from theemitter-to-tissue distance d_(e).

In various instances, the receiver 508 for the distance sensor system504 can be mounted on a separate surgical device instead of the surgicaldevice 502. For example, the receiver 508 can be mounted on a cannula ortrocar through which the surgical device 502 extends to reach thesurgical site. In still other instances, the receiver 508 for thedistance sensor system 504 can be mounted on a separaterobotically-controlled arm (e.g. the robotic arm 512, 514), on a movablearm that is operated by another robot, and/or to an operating room (OR)table or fixture. In certain instances, the imaging device 520 includesthe time-of-flight receiver 508 to determine the distance from theemitter 506 to the surface 505 of the tissue 503 using a line betweenthe emitter 506 on the surgical device 502 and the imaging device 520.For example, the distance d_(e) can be triangulated based on knownpositions of the emitter 506 (e.g, on the surgical device 502) and thereceiver 508 (e.g. on the imaging device 520) of the distance sensorsystem 504. The three-dimensional position of the receiver 508 can beknown and/or registered to the robot coordinate plane intraoperatively.

In certain instances, the position of the emitter 506 of the distancesensor system 504 can be controlled by the first robotic arm 512 and theposition of the receiver 508 of the distance sensor system 504 can becontrolled by the second robotic arm 514. In other instances, thesurgical visualization system 500 can be utilized apart from a roboticsystem. In such instances, the distance sensor system 504 can beindependent of the robotic system.

In certain instances, one or more of the robotic arms 512, 514 may beseparate from a main robotic system used in the surgical procedure. Atleast one of the robotic arms 512, 514 can be positioned and registeredto a particular coordinate system without servomotor control. Forexample, a closed-loop control system and/or a plurality of sensors forthe robotic arms 512, 514 can control and/or register the position ofthe robotic arm(s) 512, 514 relative to the particular coordinatesystem. Similarly, the position of the surgical device 502 and theimaging device 520 can be registered relative to a particular coordinatesystem.

Referring still to FIG. 24, d_(w) is the camera-to-critical structuredistance from the optical waveform emitter 523 located on the imagingdevice 520 to the surface of the critical structure 501 a, and d_(A) isthe depth of the critical structure 501 b below the surface 505 of thetissue 503 (i.e., the distance between the portion of the surface 505closest to the surgical device 502 and the critical structure 501 b). Invarious aspects, the time-of-flight of the optical waveforms emittedfrom the optical waveform emitter 523 located on the imaging device 520can be configured to determine the camera-to-critical structure distanced_(w). The use of spectral imaging in combination with time-of-flightsensors is further described herein.

In one aspect, the surgical visualization system 500 is configured todetermine an emitter-to-tissue distance d_(e) from an emitter 506 on thesurgical device 502 to a surface 505 of the uterus via structured light.The surgical visualization system 500 is configured to extrapolate adevice-to-tissue distance d_(t) from the surgical device 502 to thesurface 505 of the uterus based on the emitter-to-tissue distance d_(e).The surgical visualization system 500 is also configured to determine atissue-to-ureter distance d_(A) from the critical structure (the ureter)501 a to the surface 505 and a camera-to ureter distance 4, from theimaging device 520 to the critical structure (the ureter) 501 a. Asdescribed herein, the surgical visualization system 500 can determinethe distance 4, with spectral imaging and time-of-flight sensors, forexample. In various instances, the surgical visualization system 500 candetermine (e.g. triangulate) the tissue-to-ureter distance d_(A) (ordepth) based on other distances and/or the surface mapping logicdescribed herein.

Referring now to FIG. 29, in various aspects of the present disclosure,in a surgical visualization system 800, the depth d_(A) of a criticalstructure 801 relative to a surface 805 of a tissue 803 can bedetermined by triangulating from the distance d_(w), and known positionsof an emitter 806 and an optical waveform emitter 823 and detector 823(and, thus, the known distance d_(x) therebetween) to determine thedistance d_(y), which is the sum of the distance d_(e) and the depthd_(A).

Additionally or alternatively, time-of-flight from the optical waveformemitter 823 can be configured to determine the distance from the opticalwaveform emitter 823 to the surface 805 of the tissue 803. For example,a first waveform (or range of waveforms) can be utilized to determinethe camera-to-critical structure distance d_(w) and a second waveform(or range of waveforms) can be utilized to determine the distance to thesurface 805 of the tissue 803. In such instances, the differentwaveforms can be utilized to determine the depth of the criticalstructure 801 below the surface 805 of the tissue 803. Spectraltime-of-flight systems are further described herein.

Additionally or alternatively, in certain instances, the distance d_(A)can be determined from an ultrasound, a registered magnetic resonanceimaging (MRI) or computerized tomography (CT) scan. In still otherinstances, the distance d_(A) can be determined with spectral imagingbecause the detection signal received by the imaging device can varybased on the type of material. For example, fat can decrease thedetection signal in a first way, or a first amount, and collagen candecrease the detection signal in a different, second way, or a secondamount.

Referring now to a surgical visualization system 860 in FIG. 30, inwhich a surgical device 862 includes the optical waveform emitter 823′and the waveform sensor 822′ that is configured to detect the reflectedwaveforms. The optical waveform emitter 823′ can be configured to emitwaveforms for determining the distances d_(t) and d_(w) common device,such as the surgical device 862, as further described herein. In suchinstances, the distance d_(A) from the surface 805 of the tissue 803 tothe surface of the critical structure 801 can be determined as follows:

d _(A) =d _(w) −d _(t).

As disclosed herein, various information regarding visible tissue,embedded critical structures, and surgical devices can be determined byutilizing a combination approach that incorporates one or moretime-of-flight distance sensors, spectral imaging, and/or structuredlight arrays in combination with an image sensor configured to detectthe spectral wavelengths and the structured light arrays. Moreover, animage sensor can be configured to receive visible light and, thus,provide images of the surgical site to an imaging system. Logic oralgorithms are employed to discern the information received from thetime-of-flight sensors, spectral wavelengths, structured light, andvisible light and render three-dimensional images of the surface tissueand underlying anatomical structures. In various instances, the imagingdevice 520 can include multiple image sensors.

The camera-to-critical structure distance d_(w) can also be detected inone or more alternative ways. In one aspect, a fluoroscopy visualizationtechnology, such as fluorescent indosciedine green (ICG), for example,can be utilized to illuminate a critical structure 3201, as shown inFIGS. 31-33. A camera 3220 can include two optical waveforms sensors3222, 3224, which take simultaneous left-side and right-side images ofthe critical structure 3201 (FIG. 32A and 32B). In such instances, thecamera 3220 can depict a glow of the critical structure 3201 below thesurface 3205 of the tissue 3203, and the distance d_(w) can bedetermined by the known distance between the sensors 3222 and 3224. Incertain instances, distances can be determined more accurately byutilizing more than one camera or by moving a camera between multiplelocations. In certain aspects, one camera can be controlled by a firstrobotic arm and a second camera by another robotic arm. In such arobotic system, one camera can be a follower camera on a follower arm,for example. The follower arm, and camera thereon, can be programmed totrack the other camera and to maintain a particular distance and/or lensangle, for example.

In still other aspects, the surgical visualization system 500 may employtwo separate waveform receivers (i.e. cameras/image sensors) todetermine d_(w). Referring now to FIG. 34, if a critical structure 3301or the contents thereof (e.g. a vessel or the contents of the vessel)can emit a signal 3302, such as with fluoroscopy, then the actuallocation can be triangulated from two separate cameras 3320 a, 3320 b atknown locations.

In another aspect, referring now to FIGS. 35A and 35B, a surgicalvisualization system may employ a dithering or moving camera 440 todetermine the distance d_(w). The camera 440 is robotically-controlledsuch that the three-dimensional coordinates of the camera 440 at thedifferent positions are known. In various instances, the camera 440 canpivot at a cannula or patient interface. For example, if a criticalstructure 401 or the contents thereof (e.g. a vessel or the contents ofthe vessel) can emit a signal, such as with fluoroscopy, for example,then the actual location can be triangulated from the camera 440 movedrapidly between two or more known locations. In FIG. 35A, the camera 440is moved axially along an axis A. More specifically, the camera 440translates a distance d₁ closer to the critical structure 401 along theaxis A to the location indicated as a location 440′, such as by movingin and out on a robotic arm. As the camera 440 moves the distance d₁ andthe size of view change with respect to the critical structure 401, thedistance to the critical structure 401 can be calculated. For example, a4.28 mm axial translation (the distance d₁) can correspond to an angleθ₁ of 6.28 degrees and an angle θ₂ of 8.19 degrees.

Additionally or alternatively, the camera 440 can rotate or sweep alongan arc between different positions. Referring now to FIG. 35B, thecamera 440 is moved axially along the axis A and is rotated an angle θ₃about the axis A. A pivot point 442 for rotation of the camera 440 ispositioned at the cannula/patient interface. In FIG. 35B, the camera 440is translated and rotated to a location 440″. As the camera 440 movesand the edge of view changes with respect to the critical structure 401,the distance to the critical structure 401 can be calculated. In FIG.35B, a distance d₂ can be 9.01 mm, for example, and the angle θ₃ can be0.9 degrees, for example.

FIG. 25 is a schematic diagram of the control system 833, which can beutilized with the surgical visualization system 500 and the inputcontrol device 1000, for example. The control system 833 includes acontrol circuit 832 in signal communication with a memory 834. Thememory 834 stores instructions executable by the control circuit 832 todetermine and/or recognize critical structures (e.g. the criticalstructures 501 a, 501 b in FIG. 24), determine and/or compute one ormore distances and/or three-dimensional digital representations, and/orto communicate certain information to one or more clinicians, amongother things. For example, the memory 834 stores surface mapping logic836, imaging logic 838, tissue identification logic 840, or distancedetermining logic 841 or any combinations of the logic 836, 838, 840,and 841. The memory 834 can also include input control device logic forimplementing the input controls provided to the input control device1000, including scaling and/or locking out certain controls in certaincircumstances and/or switching between operational modes based onreal-time, intraoperative tissue proximity data, for example. Thecontrol system 833 also includes an imaging system 842 having one ormore cameras 844 (like the imaging device 520 in FIG. 24), one or moredisplays 846, or one or more controls 848 or any combinations of theseelements. The camera 844 can include one or more image sensors 835 toreceive signals from various light sources emitting light at variousvisible and invisible spectra (e.g. visible light, spectral imagers,three-dimensional lens, among others). The display 846 can include oneor more screens or monitors for depicting real, virtual, and/orvirtually-augmented images and/or information to one or more clinicians.

In various aspects, the heart of the camera 844 is the image sensor 835.Generally, modern image sensors 835 are solid-state electronic devicescontaining up to millions of discrete photodetector sites called pixels.The image sensor 835 technology falls into one of two categories:Charge-Coupled Device (CCD) and Complementary Metal Oxide Semiconductor(CMOS) imagers and more recently, short-wave infrared (SWIR) is anemerging technology in imaging. Another type of image sensor 835 employsa hybrid CCD/CMOS architecture (sold under the name “sCMOS”) andconsists of CMOS readout integrated circuits (ROICs) that are bumpbonded to a CCD imaging substrate. CCD and CMOS image sensors 835 aresensitive to wavelengths from approximately 350-1050 nm, although therange is usually given from 400-1000 nm. CMOS sensors are, in general,more sensitive to IR wavelengths than CCD sensors. Solid state imagesensors 835 are based on the photoelectric effect and, as a result,cannot distinguish between colors. Accordingly, there are two types ofcolor CCD cameras: single chip and three-chip. Single chip color CCDcameras offer a common, low-cost imaging solution and use a mosaic (e.g.Bayer) optical filter to separate incoming light into a series of colorsand employ an interpolation algorithm to resolve full color images. Eachcolor is, then, directed to a different set of pixels. Three-chip colorCCD cameras provide higher resolution by employing a prism to directeach section of the incident spectrum to a different chip. More accuratecolor reproduction is possible, as each point in space of the object hasseparate RGB intensity values, rather than using an algorithm todetermine the color. Three-chip cameras offer extremely highresolutions.

The control system 833 also includes a spectral light source 850 and astructured light source 852. In certain instances, a single source canbe pulsed to emit wavelengths of light in the spectral light source 850range and wavelengths of light in the structured light source 852 range.Alternatively, a single light source can be pulsed to provide light inthe invisible spectrum (e.g. infrared spectral light) and wavelengths oflight on the visible spectrum. The spectral light source 850 can be ahyperspectral light source, a multispectral light source, and/or aselective spectral light source, for example. In various instances, thetissue identification logic 840 can identify critical structure(s) viadata from the spectral light source 850 received by the image sensor 835portion of the camera 844. The surface mapping logic 836 can determinethe surface contours of the visible tissue based on reflected structuredlight. With time-of-flight measurements, the distance determining logic841 can determine one or more distance(s) to the visible tissue and/or acritical structure. One or more outputs from the surface mapping logic836, the tissue identification logic 840, and the distance determininglogic 841, can be provided to the imaging logic 838, and combined,blended, and/or overlaid to be conveyed to a clinician via the display846 of the imaging system 842.

The description now turns briefly to FIGS. 26-28 to describe variousaspects of the control circuit 832 for controlling various aspects ofthe surgical visualization system 500. Turning to FIG. 26, there isillustrated a control circuit 400 configured to control aspects of thesurgical visualization system 500, according to at least one aspect ofthis disclosure. The control circuit 400 can be configured to implementvarious processes described herein. The control circuit 400 may comprisea microcontroller comprising one or more processors 402 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit404. The memory circuit 404 stores machine-executable instructions that,when executed by the processor 402, cause the processor 402 to executemachine instructions to implement various processes described herein.The processor 402 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 404 may comprisevolatile and non-volatile storage media. The processor 402 may includean instruction processing unit 406 and an arithmetic unit 408. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 404 of this disclosure.

FIG. 27 illustrates a combinational logic circuit 410 configured tocontrol aspects of the surgical visualization system 500, according toat least one aspect of this disclosure. The combinational logic circuit410 can be configured to implement various processes described herein.The combinational logic circuit 410 may comprise a finite state machinecomprising a combinational logic 412 configured to receive dataassociated with the surgical instrument or tool at an input 414, processthe data by the combinational logic 412, and provide an output 416.

FIG. 28 illustrates a sequential logic circuit 420 configured to controlaspects of the surgical visualization system 500, according to at leastone aspect of this disclosure. The sequential logic circuit 420 or thecombinational logic 422 can be configured to implement various processesdescribed herein. The sequential logic circuit 420 may comprise a finitestate machine. The sequential logic circuit 420 may comprise acombinational logic 422, at least one memory circuit 424, and a clock429, for example. The at least one memory circuit 424 can store acurrent state of the finite state machine. In certain instances, thesequential logic circuit 420 may be synchronous or asynchronous. Thecombinational logic 422 is configured to receive data associated with asurgical device or system from an input 426, process the data by thecombinational logic 422, and provide an output 428. In other aspects,the circuit may comprise a combination of a processor (e.g., processor402 in FIG. 26) and a finite state machine to implement variousprocesses herein. In other aspects, the finite state machine maycomprise a combination of a combinational logic circuit (e.g.,combinational logic circuit 410, FIG. 27) and the sequential logiccircuit 420.

Referring now to FIG. 36, where a schematic of a control system 600 fora surgical visualization system, such as the surgical visualizationsystem 500, for example, is depicted. The control system 600 is aconversion system that integrates spectral signature tissueidentification and structured light tissue positioning to identifycritical structures, especially when those structures are obscured byother tissue, such as fat, connective tissue, blood, and/or otherorgans, for example. Such technology could also be useful for detectingtissue variability, such as differentiating tumors and/or non-healthytissue from healthy tissue within an organ.

The control system 600 is configured for implementing a hyperspectralimaging and visualization system in which a molecular response isutilized to detect and identify anatomy in a surgical field of view. Thecontrol system 600 includes a conversion logic circuit 648 to converttissue data to surgeon usable information. For example, the variablereflectance based on wavelengths with respect to obscuring material canbe utilized to identify the critical structure in the anatomy. Moreover,the control system 600 combines the identified spectral signature andthe structural light data in an image. For example, the control system600 can be employed to create of three-dimensional data set for surgicaluse in a system with augmentation image overlays. Techniques can beemployed both intraoperatively and preoperatively using additionalvisual information. In various instances, the control system 600 isconfigured to provide warnings to a clinician when in the proximity ofone or more critical structures. Various algorithms can be employed toguide robotic automation and semi-automated approaches based on thesurgical procedure and proximity to the critical structure(s).

A projected array of lights is employed to determine tissue shape andmotion intraoperatively. Alternatively, flash Lidar may be utilized forsurface mapping of the tissue.

The control system 600 is configured to detect the critical structure(s)and provide an image overlay of the critical structure and measure thedistance to the surface of the visible tissue and the distance to theembedded/buried critical structure(s). In other instances, the controlsystem 600 can measure the distance to the surface of the visible tissueor detect the critical structure(s) and provide an image overlay of thecritical structure.

The control system 600 includes a spectral control circuit 602. Thespectral control circuit 602 can be a field programmable gate array(FPGA) or another suitable circuit configuration as described herein inconnection with FIGS. 26-28, for example. The spectral control circuit602 includes a processor 604 to receive video input signals from a videoinput processor 606. The processor 604 can be configured forhyperspectral processing and can utilize C/C++ code, for example. Thevideo input processor 606 receives video-in of control (metadata) datasuch as shutter time, wavelength, and sensor analytics, for example. Theprocessor 604 is configured to process the video input signal from thevideo input processor 606 and provide a video output signal to a videooutput processor 608, which includes a hyperspectral video-out ofinterface control (metadata) data, for example. The video outputprocessor 608 provides the video output signal to an image overlaycontroller 610.

The video input processor 606 is coupled to a camera 612 at the patientside via a patient isolation circuit 614. As previously discussed, thecamera 612 includes a solid state image sensor 634. The patientisolation circuit can include a plurality of transformers so that thepatient is isolated from other circuits in the system. The camera 612receives intraoperative images through optics 632 and the image sensor634. The image sensor 634 can include a CMOS image sensor, for example,or may include any of the image sensor technologies discussed herein inconnection with FIG. 25, for example. In one aspect, the camera 612outputs images in 14 bit / pixel signals It will be appreciated thathigher or lower pixel resolutions may be employed without departing fromthe scope of the present disclosure. The isolated camera output signal613 is provided to a color RGB fusion circuit 616, which employs ahardware register 618 and a Nios2 co-processor 620 to process the cameraoutput signal 613. A color RGB fusion output signal is provided to thevideo input processor 606 and a laser pulsing control circuit 622.

The laser pulsing control circuit 622 controls a laser light engine 624.The laser light engine 624 outputs light in a plurality of wavelengths(80 ₁, λ₂, λ₃ . . . λ_(n)) including near infrared (NIR). The laserlight engine 624 can operate in a plurality of modes. In one aspect, thelaser light engine 624 can operate in two modes, for example. In a firstmode, e.g. a normal operating mode, the laser light engine 624 outputsan illuminating signal. In a second mode, e.g. an identification mode,the laser light engine 624 outputs RGBG and NIR light. In variousinstances, the laser light engine 624 can operate in a polarizing mode.

Light output 626 from the laser light engine 624 illuminates targetedanatomy in an intraoperative surgical site 627. The laser pulsingcontrol circuit 622 also controls a laser pulse controller 628 for alaser pattern projector 630 that projects a laser light pattern 631,such as a grid or pattern of lines and/or dots, at a predeterminedwavelength (λ) on the operative tissue or organ at the surgical site627. The camera 612 receives the patterned light as well as thereflected light output through the camera optics 632. The image sensor634 converts the received light into a digital signal.

The color RGB fusion circuit 616 also outputs signals to the imageoverlay controller 610 and a video input module 636 for reading thelaser light pattern 631 projected onto the targeted anatomy at thesurgical site 627 by the laser pattern projector 630. A processingmodule 638 processes the laser light pattern 631 and outputs a firstvideo output signal 640 representative of the distance to the visibletissue at the surgical site 627. The data is provided to the imageoverlay controller 610. The processing module 638 also outputs a secondvideo signal 642 representative of a three-dimensional rendered shape ofthe tissue or organ of the targeted anatomy at the surgical site.

The first and second video output signals 640, 642 include datarepresentative of the position of the critical structure on athree-dimensional surface model, which is provided to an integrationmodule 643. In combination with data from the video out processor 608 ofthe spectral control circuit 602, the integration module 643 candetermine the distance d_(A) (FIG. 24) to a buried critical structure(e.g. via triangularization algorithms 644), and the distance d_(A) canbe provided to the image overlay controller 610 via a video outprocessor 646. The foregoing conversion logic can encompass theconversion logic circuit 648 intermediate video monitors 652 and thecamera 612, the laser light engine 624, and laser pattern projector 630positioned at the surgical site 627.

Preoperative data 650 from a CT or MRI scan can be employed to registeror align certain three-dimensional deformable tissue in variousinstances. Such preoperative data 650 can be provided to the integrationmodule 643 and ultimately to the image overlay controller 610 so thatsuch information can be overlaid with the views from the camera 612 andprovided to the video monitors 652. Registration of preoperative data isfurther described herein and in U.S. patent application Ser. No.16/128,195, titled INTEGRATION OF IMAGING DATA, filed Sep. 11, 2018, forexample, which is incorporated by reference herein in its entirety.

The video monitors 652 can output the integrated/augmented views fromthe image overlay controller 610. A clinician can select and/or togglebetween different views on one or more monitors. On a first monitor 652a, the clinician can toggle between (A) a view in which athree-dimensional rendering of the visible tissue is depicted and (B) anaugmented view in which one or more hidden critical structures aredepicted over the three-dimensional rendering of the visible tissue. Ona second monitor 652 b, the clinician can toggle on distancemeasurements to one or more hidden critical structures and/or thesurface of visible tissue, for example.

The control system 600 and/or various control circuits thereof can beincorporated into various surgical visualization systems disclosedherein.

In various instances, select wavelengths for spectral imaging can beidentified and utilized based on the anticipated critical structuresand/or obscurants at a surgical site (i.e. “selective spectral”imaging). By utilizing selective spectral imaging, the amount of timerequired to obtain the spectral image can be minimized such that theinformation can be obtained in real-time, or near real-time, andutilized intraoperatively. In various instances, the wavelengths can beselected by a clinician or by a control circuit based on input by theclinician. In certain instances, the wavelengths can be selected basedon machine learning and/or big data accessible to the control circuitvia a cloud, for example.

The foregoing application of spectral imaging to tissue can be utilizedintraoperatively to measure the distance between a waveform emitter anda critical structure that is obscured by tissue. In one aspect of thepresent disclosure, referring now to FIGS. 41 and 42, a time-of-flightsensor system 2104 utilizing waveforms 2124, 2125 is shown. Thetime-of-flight sensor system 2104 can be incorporated into the surgicalvisualization system 500 (FIG. 24) in certain instances. Thetime-of-flight sensor system 2104 includes a waveform emitter 2106 and awaveform receiver 2108 on the same surgical device 2102. The emittedwave 2124 extends to the critical structure 2101 from the emitter 2106and the received wave 2125 is reflected back to the receiver 2108 fromthe critical structure 2101. The surgical device 2102 is positionedthrough a trocar 2110 that extends into a cavity 2107 in a patient.

The waveforms 2124, 2125 are configured to penetrate obscuring tissue2103. For example, the wavelengths of the waveforms 2124, 2125 can be inthe NIR or SWIR spectrum of wavelengths. In one aspect, a spectralsignal (e.g. hyperspectral, multispectral, or selective spectral) or aphotoacoustic signal can be emitted from the emitter 2106 and canpenetrate the tissue 2103 in which the critical structure 2101 isconcealed. The emitted waveform 2124 can be reflected by the criticalstructure 2101. The received waveform 2125 can be delayed due to thedistance d between the distal end of the surgical device 2102 and thecritical structure 2101. In various instances, the waveforms 2124, 2125can be selected to target the critical structure 2101 within the tissue2103 based on the spectral signature of the critical structure 2101, asfurther described herein. In various instances, the emitter 2106 isconfigured to provide a binary signal on and off, as shown in FIG. 42,for example, which can be measured by the receiver 2108.

Based on the delay between the emitted wave 2124 and the received wave2125, the time-of-flight sensor system 2104 is configured to determinethe distance d (FIG. 41). A time-of-flight timing diagram 2130 for theemitter 2106 and the receiver 2108 of FIG. 41 is shown in FIG. 42. Thedelay is a function of the distance d and the distance d is given by:

$d = {\frac{ct}{2} \cdot \frac{q_{2}}{q_{1} + q_{2}}}$

where:

c=the speed of light;

t=length of pulse;

q₁=accumulated charge while light is emitted; and

q₂=accumulated charge while light is not being emitted.

As provided herein, the time-of-flight of the waveforms 2124, 2125corresponds to the distance din FIG. 41. In various instances,additional emitters/receivers and/or pulsing signals from the emitter2106 can be configured to emit a non-penetrating signal. Thenon-penetrating tissue can be configured to determine the distance fromthe emitter to the surface 2105 of the obscuring tissue 2103. In variousinstances, the depth of the critical structure 2101 can be determinedby:

d _(A) =d _(w) −d _(t).

where:

d_(A)=the depth of the critical structure 2101 below the surface 2105 ofthe obscuring tissue 2103;

d_(w)=the distance from the emitter 2106 to the critical structure 2101(din FIG. 41); and

d_(t,)=the distance from the emitter 2106 (on the distal end of thesurgical device 2102) to the surface 2105 of the obscuring tissue 2103.

In one aspect of the present disclosure, referring now to FIG. 43, atime-of-flight sensor system 2204 utilizing waves 2224 a, 2224 b, 2224c, 2225 a, 2225 b, 2225 c is shown. The time-of-flight sensor system2204 can be incorporated into the surgical visualization system 500(FIG. 24) in certain instances. The time-of-flight sensor system 2204includes a waveform emitter 2206 and a waveform receiver 2208. Thewaveform emitter 2206 is positioned on a first surgical device 2202 a,and the waveform receiver 2208 is positioned on a second surgical device2202 b. The surgical devices 2202 a, 2202 b are positioned through theirrespective trocars 2210 a, 2210 b, respectively, which extend into acavity 2207 in a patient. The emitted waves 2224 a, 2224 b, 2224 cextend toward a surgical site from the emitter 2206 and the receivedwaves 2225 a, 2225 b, 2225 c are reflected back to the receiver 2208from various structures and/or surfaces at the surgical site.

The different emitted waves 2224 a, 2224 b, 2224 c are configured totarget different types of material at the surgical site. For example,the wave 2224 a targets the obscuring tissue 2203, the wave 2224 btargets a first critical structure 2201 a (e.g. a vessel), and the wave2224 c targets a second critical structure 2201 b (e.g. a canceroustumor). The wavelengths of the waves 2224 a, 2224 b, 2224 c can be inthe visible light, NIR, or SWIR spectrum of wavelengths. For example,visible light can be reflected off a surface 2205 of the tissue 2203 andNIR and/or SWIR waveforms can be configured to penetrate the surface2205 of the tissue 2203. In various aspects, as described herein, aspectral signal (e.g. hyperspectral, multispectral, or selectivespectral) or a photoacoustic signal can be emitted from the emitter2206. In various instances, the waves 2224 b, 2224 c can be selected totarget the critical structures 2201 a, 2201 b within the tissue 2203based on the spectral signature of the critical structures 2201 a, 2201b, as further described herein.

The emitted waves 2224 a, 2224 b, 2224 c can be reflected off thetargeted material (i.e. the surface 2205, the first critical structure2201 a, and the second structure 2201 b, respectively). The receivedwaveforms 2225 a, 2225 b, 2225 c can be delayed due to the distancesd_(1a), d_(2a), d_(3a), d_(1b), d_(2b), d_(3b) indicated in FIG. 43.

In the time-of-flight sensor system 2204, in which the emitter 2206 andthe receiver 2208 are independently positionable (e.g., on separatesurgical devices 2202 a, 2202 b and/or controlled by separate roboticarms), the various distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(3b) can be calculated from the known position of the emitter 2206 andthe receiver 2208. For example, the positions can be known when thesurgical devices 2202 a, 2202 b are robotically-controlled. Knowledge ofthe positions of the emitter 2206 and the receiver 2208, as well as thetime of the photon stream to target a certain tissue and the informationreceived by the receiver 2208 of that particular response can allow adetermination of the distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(3b). In one aspect, the distance to the obscured critical structures2201 a, 2201 b can be triangulated using penetrating wavelengths.Because the speed of light is constant for any wavelength of visible orinvisible light, the time-of-flight sensor system 2204 can determine thevarious distances.

Referring still to FIG. 43, in various instances, in the view providedto the clinician, the receiver 2208 can be rotated such that the centerof mass of the target structure in the resulting images remainsconstant, i.e., in a plane perpendicular to the axis of a select targetstructures 2203, 2201 a, or 2201 b. Such an orientation can quicklycommunicate one or more relevant distances and/or perspectives withrespect to the critical structure. For example, as shown in FIG. 43, thesurgical site is displayed from a viewpoint in which the first criticalstructure 2201 a is perpendicular to the viewing plane (i.e. the vesselis oriented in/out of the page). In various instances, such anorientation can be the default setting; however, the view can be rotatedor otherwise adjusted by a clinician. In certain instances, theclinician can toggle between different surfaces and/or target structuresthat define the viewpoint of the surgical site provided by the imagingsystem.

In various instances, the receiver 2208 can be mounted on a trocar orcannula, such as the trocar 2210 b, for example, through which thesecond surgical device 2202 b is positioned. In other instances, thereceiver 2208 can be mounted on a separate robotic arm for which thethree-dimensional position is known. In various instances, the receiver2208 can be mounted on a movable arm that is separate from the robotthat controls the first surgical device 2202 a or can be mounted to anoperating room (OR) table that is intraoperatively registerable to therobot coordinate plane. In such instances, the position of the emitter2206 and the receiver 2208 can be registerable to the same coordinateplane such that the distances can be triangulated from outputs from thetime-of-flight sensor system 2204.

Combining time-of-flight sensor systems and near-infrared spectroscopy(NIRS), termed TOF-NIRS, which is capable of measuring the time-resolvedprofiles of NIR light with nanosecond resolution can be found in thearticle titled TIME-OF-FLIGHT NEAR-INFRARED SPECTROSCOPY FORNONDESTRUCTIVE MEASUREMENT OF INTERNAL QUALITY IN GRAPEFRUIT, in theJournal of the American Society for Horticultural Science, May 2013 vol.138 no. 3 225-228, which is incorporated by reference herein in itsentirety, and is accessible atjournal.ashspublications.org/content/138/3/225.full.

In various instances, time-of-flight spectral waveforms are configuredto determine the depth of the critical structure and/or the proximity ofa surgical device to the critical structure. Moreover, the varioussurgical visualization systems disclosed herein include surface mappinglogic that is configured to create three-dimensional rendering of thesurface of the visible tissue. In such instances, even when the visibletissue obstructs a critical structure, the clinician can be aware of theproximity (or lack thereof) of a surgical device to the criticalstructure. In one instance, the topography of the surgical site isprovided on a monitor by the surface mapping logic. If the criticalstructure is close to the surface of the tissue, spectral imaging canconvey the position of the critical structure to the clinician. Forexample, spectral imaging may detect structures within 5 or 10 mm of thesurface. In other instances, spectral imaging may detect structures 10or 20 mm below the surface of the tissue. Based on the known limits ofthe spectral imaging system, the system is configured to convey that acritical structure is out-of-range if it is simply not detected by thespectral imaging system. Therefore, the clinician can continue to movethe surgical device and/or manipulate the tissue. When the criticalstructure moves into range of the spectral imaging system, the systemcan identify the structure and, thus, communicate that the structure iswithin range. In such instances, an alert can be provided when astructure is initially identified and/or moved further within apredefined proximity zone. In such instances, even non-identification ofa critical structure by a spectral imaging system with knownbounds/ranges can provide proximity information (i.e. the lack ofproximity) to the clinician.

Various surgical visualization systems disclosed herein can beconfigured to identify intraoperatively the presence of and/or proximityto critical structure(s) and to alert a clinician prior to damaging thecritical structure(s) by inadvertent dissection and/or transection. Invarious aspects, the surgical visualization systems are configured toidentify one or more of the following critical structures: ureters,bowel, rectum, nerves (including the phrenic nerve, recurrent laryngealnerve [RLN], promontory facial nerve, vagus nerve, and branchesthereof), vessels (including the pulmonary and lobar arteries and veins,inferior mesenteric artery [IMA] and branches thereof, superior rectalartery, sigmoidal arteries, and left colic artery), superior mesentericartery (SMA) and branches thereof (including middle colic artery, rightcolic artery, ilecolic artery), hepatic artery and branches thereof,portal vein and branches thereof, splenic artery/vein and branchesthereof, external and internal (hypogastric) ileac vessels, shortgastric arteries, uterine arteries, middle sacral vessels, and lymphnodes, for example. Moreover, the surgical visualization systems areconfigured to indicate proximity of surgical device(s) to the criticalstructure(s) and/or warn the clinician when surgical device(s) aregetting close to the critical structure(s).

Various aspects of the present disclosure provide intraoperativecritical structure identification (e.g., identification of ureters,nerves, and/or vessels) and instrument proximity monitoring. Forexample, various surgical visualization systems disclosed herein caninclude spectral imaging and surgical instrument tracking, which enablethe visualization of critical structures below the surface of thetissue, such as 1.0-1.5 cm below the surface of the tissue, for example.In other instances, the surgical visualization system can identifystructures less than 1.0 cm or more the 1.5 cm below the surface of thetissue. For example, even a surgical visualization system that canidentify structures only within 0.2 mm of the surface, for example, canbe valuable if the structure cannot otherwise be seen due to the depth.In various aspects, the surgical visualization system can augment theclinician's view with a virtual depiction of the critical structure as avisible white-light image overlay on the surface of visible tissue, forexample. The surgical visualization system can provide real-time,three-dimensional spatial tracking of the distal tip of surgicalinstruments and can provide a proximity alert when the distal tip of asurgical instrument moves within a certain range of the criticalstructure, such as within 1.0 cm of the critical structure, for example.

Various surgical visualization systems disclosed herein can identifywhen dissection is too close to a critical structure. Dissection may be“too close” to a critical structure based on the temperature (i.e. toohot within a proximity of the critical structure that may riskdamaging/heating/melting the critical structure) and/or based on tension(i.e. too much tension within a proximity of the critical structure thatmay risk damaging/tearing/pulling the critical structure). Such asurgical visualization system can facilitate dissection around vesselswhen skeletonizing the vessels prior to ligation, for example. Invarious instances, a thermal imaging camera can be utilized to read theheat at the surgical site and provide a warning to the clinician that isbased on the detected heat and the distance from a tool to thestructure. For example, if the temperature of the tool is over apredefined threshold (such as 120 degrees F., for example), an alert canbe provided to the clinician at a first distance (such as 10 mm, forexample), and if the temperature of the tool is less than or equal tothe predefined threshold, the alert can be provided to the clinician ata second distance (such as 5 mm, for example). The predefined thresholdsand/or warning distances can be default settings and/or programmable bythe clinician. Additionally or alternatively, a proximity alert can belinked to thermal measurements made by the tool itself, such as athermocouple that measures the heat in a distal jaw of a monopolar orbipolar dissector or vessel sealer, for example.

Various surgical visualization systems disclosed herein can provideadequate sensitivity with respect to a critical structure andspecificity to enable a clinician to proceed with confidence in a quickbut safe dissection based on the standard of care and/or device safetydata. The system can function intraoperatively and in real-time during asurgical procedure with minimal ionizing radiation risk to a patient ora clinician and, in various instances, no risk of ionizing radiationrisk to the patient or the clinician. Conversely, in a fluoroscopyprocedure, the patient and clinician(s) may be exposed to ionizingradiation via an X-ray beam, for example, that is utilized to view theanatomical structures in real-time.

Various surgical visualization system disclosed herein can be configuredto detect and identify one or more desired types of critical structuresin a forward path of a surgical device, such as when the path of thesurgical device is robotically controlled, for example. Additionally oralternatively, the surgical visualization system can be configured todetect and identify one or more types of critical structures in asurrounding area of the surgical device and/or in multipleplanes/dimensions, for example.

Various surgical visualization systems disclosed herein can be easy tooperate and/or interpret. Moreover, various surgical visualizationsystems can incorporate an “override” feature that allows the clinicianto override a default setting and/or operation. For example, a cliniciancan selectively turn off alerts from the surgical visualization systemand/or get closer to a critical structure than suggested by the surgicalvisualization system such as when the risk to the critical structure isless than risk of avoiding the area (e.g. when removing cancer around acritical structure the risk of leaving the cancerous tissue can begreater than the risk of damage to the critical structure).

Various surgical visualization systems disclosed herein can beincorporated into a surgical system and/or used during a surgicalprocedure with limited impact to the workflow. In other words,implementation of the surgical visualization system may not change theway the surgical procedure is implemented. Moreover, the surgicalvisualization system can be economical in comparison to the costs of aninadvertent transection. Data indicates the reduction in inadvertentdamage to a critical structure can drive incremental reimbursement.

Various surgical visualization systems disclosed herein can operate inreal-time, or near real-time, and far enough in advance to enable aclinician to anticipate critical structure(s). For example, a surgicalvisualization system can provide enough time to “slow down, evaluate,and avoid” in order to maximize efficiency of the surgical procedure.

Various surgical visualization systems disclosed herein may not requirea contrast agent, or dye, that is injected into tissue. For example,spectral imaging is configured to visualize hidden structuresintraoperatively without the use of a contrast agent or dye. In otherinstances, the contrast agent can be easier to inject into the properlayer(s) of tissue than other visualization systems. The time betweeninjection of the contrast agent and visualization of the criticalstructure can be less than two hours, for example.

Various surgical visualization systems disclosed herein can be linkedwith clinical data and/or device data. For example, data can provideboundaries for how close energy-enabled surgical devices (or otherpotentially damaging devices) should be from tissue that the surgeondoes not want to damage. Any data modules that interface with thesurgical visualization systems disclosed herein can be providedintegrally or separately from a robot to enable use with stand-alonesurgical devices in open or laparoscopic procedures, for example. Thesurgical visualization systems can be compatible with robotic surgicalsystems in various instances. For example, the visualizationimages/information can be displayed in a robotic console.

Various surgical visualization systems disclosed herein can provideenhanced visualization data and additional information to the surgeon(s)and/or the control unit for a robotic system and/or controller thereforto improve, enhance, and/or inform the input control device and/orcontrols for the robotic system.

Additional Control Systems

Certain surgeons may be accustomed to using handheld surgical instrumentin which a displacement of the handle portion of the surgical instrumenteffects a corresponding displacement of the end effector portion of thesurgical instrument. For example, advancing the handle of a surgicalinstrument one inch can cause the end effector of the surgicalinstrument to be advanced a corresponding one inch. Such one-to-onecorrelations between inputs and outputs can be preferred by certainsurgeons utilizing robotic applications as well. For example, whenmoving a robotic surgical end effector around tissue, one-to-onecorrelations between input motions and output motions can provide anintuitive control motion. Though one-to-one correlations can bedesirable in certain instances, without the assistance of a clutchingmechanism, such input motions may not be feasible or practical whendisplacing a surgical tool across large distances. Moreover, one-to-onecorrelations may not be necessary or desired in certain instances;however, a surgeon can prefer a displacement input motion (translatingand/or rotating) when controlling a robotic surgical tool in certaininstances, such as during a precision motion mode.

A clutchless input control device can allow limited translation of aportion thereof during a precision motion mode and can rely on forcesensing technology, such as the space joint 1006 and the sensorarrangement 1048 (FIGS. 8 and 9) during a gross motion mode. Tissueproximity data can toggle the input control device between the precisionmotion mode and the gross motion mode. In such instances, the surgeoncan utilize force sensors to drive a surgical end effector largedistances toward tissue and, upon reaching a predefined proximity to thetissue, can utilize the limited translation of the portion of theclutchless input control device to provide displacement input motions tocontrol the robotic surgical tool.

Referring now to FIGS. 44-49, an input control device 4000 is shown. Theinput control device 4000 is a clutchless input control device, asfurther described herein. The input control device 4000 can be utilizedat a surgeon's console or workspace for a robotic surgical system. Forexample, the input control device 4000 can be incorporated into asurgical system, such as the surgical system 110 (FIG. 1) or thesurgical system 150 (FIG. 3), for example, to provide control signals toa surgical robot and/or surgical tool coupled thereto. The input controldevice 4000 includes manual input controls for moving the robotic armand/or the surgical tool in three-dimensional space. For example, thesurgical tool controlled by the input control device 4000 can beconfigured to move in three-dimensional space and rotate or articulateabout multiple axes (e.g. roll about a longitudinal tool axis andarticulate about one or more articulation axes).

The input control device 4000 includes a multi-dimensional space joint4006 having a central portion 4002 supported on a base 4004, similar tothe multi-dimensional space joint 1006, the central portion 1002, andthe base 1004 of the input control device 1000 (FIGS. 6-11) in manyrespects. For example, the base 4004 is structured to rest on a surface,such as a desk or work surface at a surgeon's console or workspace andcan remain in a fixed, stationary position relative to an underlyingsurface upon application of the input control motions to the inputcontrol device 4000. The space joint 4006 is configured to receivemulti-dimensional inputs corresponding to control motions for thesurgical tool in multi-dimensional space. A power cord 4032 extends fromthe base 4004. The input control device 4000 also include a multi-axisforce and/or torque sensor arrangement 4048 (FIG. 46), similar to thesensor arrangement 1048 (FIGS. 8 and 9) in many respects. For example,the sensor arrangement 4048 is configured to detect forces and momentsat the space joint 4006, such as forces applied to the central portion4002. Multi-dimensional space joints and sensor arrangements thereforare further described herein.

The central portion 4002 is flexibly supported relative to the base4004. In such instances, the central portion 4002 can be configured tomove or float within a small predefined zone upon receipt of forcecontrol inputs thereto. For example, the central portion 4002 can be afloating shaft that is supported on the base 4004 by one or moreelastomeric members such as springs, for example. The central portion4002 can be configured to move or float within a predefinedthree-dimensional volume. For example, elastomeric couplings can permitmovement of the central portion 4002 relative to the base 4004; however,restraining plates, pins, and/or other structures can be configured tolimit the range of motion of the central portion 4002 relative to thebase 4004. In one aspect, movement of the central portion 4002 from acentral or “home” position relative to the base 4004 can be permittedwithin a range of about 1.0 mm to about 5.0 mm in any direction (up,down, left, right, backwards and forwards). In other instances, movementof the central portion 4002 relative to the base 4004 can be restrainedto less than 1.0 mm or more than 5.0 mm. In certain instances, thecentral portion 4002 can move about 2.0 mm in all directions relative tothe base 4004 and, in still other instances, the central portion 4002can remain stationary or fixed relative to the base 4004.

In various instances, the central portion 4002 of the space joint 4006can be spring-biased toward the central or home position, in which thecentral portion 4002 is aligned with the Z axis, a vertical axis throughthe central portion 4002 and the space joint 4006. Driving (e.g. pushingand/or pulling) the central portion 4002 away from the Z axis in anydirection can be configured to “drive” an end effector of an associatedsurgical tool in the corresponding direction. When the external drivingforce is removed, the central portion 4002 can be configured to returnto the central or home position and motion of the end effector can behalted. Controlling the robotic surgical tool by forces applied to thesensor arrangement 4048 at the space joint 4006 can be permitted duringportions of a surgical procedure, such as during a gross motion mode, asfurther described herein.

In various instances, the space joint 4006 and the central portion 4002coupled thereto define a six degree-of-freedom input control. Referringagain to the end effector 1052 of the surgical tool 1050 in FIG. 12, theforces on the central portion 4002 of the input control device 4000 inthe X direction correspond to displacement of the end effector 1052along the X_(t) axis thereof (e.g. longitudinally), forces on thecentral portion 4002 in the Y direction correspond to displacement ofthe end effector 1052 along the Y_(t) axis thereof (e.g. laterally), andforces on the central portion 4002 in the Z direction correspond todisplacement of the end effector 1052 along the Z_(t) axis (e.g.vertically/up and down). Additionally, forces on the central portion4002 about the X axis (the moment forces R) result in rotation of theend effector 1052 about the X_(t) axis (e.g. a rolling motion about alongitudinal axis in the direction R_(t)), forces on the central portion4002 about the Y axis (the moments forces P) result in articulation ofthe end effector 1052 about the Y_(t) axis (e.g. a pitching motion inthe direction P_(t)), and forces on the central portion 4002 about the Zaxis (the moment forces T) result in articulation of the end effector1052 about the Z_(t) axis of the end effector (e.g. a yawing or twistingmotion in the direction T₁). In such instances, the input control device4000 includes a six-degree of freedom joystick, for example, which isconfigured to receive and detect six degree-of-freedom—forces along theX, Y, and Z axes and moments about the X, Y, and Z axes. The forces cancorrespond to translational input and the moments can correspond torotational inputs for the end effector 1052 of the associated surgicaltool 1050. Six degree-of-freedom input devices are further describedherein.

Referring again to the input control device 4000 in FIGS. 44-49, aforearm support 4008 is movably coupled to the base 4004. For example, amechanical joint 4042 incorporated into the central portion 4002 canhold or support the forearm support 4008 such that the forearm support4008 is movable at the mechanical joint 4042 relative to the base 4004.Referring primarily now to FIG. 47, the forearm support 4008 is shown ina first configuration (solid lines) and in a second configuration(dashed lines). The base 4004 of the input control device 4000 remainsstationary as an upper portion (e.g. a collective unit 4011 describedherein) of the input control device 4000 is displaced along alongitudinal shaft axis S, which extends parallel to the longitudinal Xaxis, between the first configuration and the second configuration. Incertain instances, the mechanical joint 4042 can permit movement of theforearm support 4008 relative to the base 4004 in multiple directions.For example, the forearm support 4008 can be moveable relative to thebase 4004 along one, two or three different axes.

The forearm support 4008 can be movable within a range of motion definedby a travel zone 4050 (FIG. 47) surrounding a forearm home position. Forexample, the travel zone 4050 can define a one-dimensional path from theforearm home position, wherein the one-dimensional path extends along alongitudinal axis between 2.0 cm and 6.0 cm from the forearm homeposition. Referring again to FIG. 47, in the first configuration(indicated as input control device 4000 in solid lines), the inputcontrol device 4000 has been moved proximally along the longitudinalshaft axis S to the proximal end or limit of the travel zone 4050 and,in the second configuration (indicated as input control device 4000′ indashed lines), the input control device 4000 has been moved distallyalong the longitudinal shaft axis S to the distal end or limit of thetravel zone 4050. In various instances, the travel zone 4050 can definea two-dimensional space extending between 2.0 cm and 6.0 cm in twodimensions from the forearm home position. In still other instances, thetravel zone 4050 can define a three-dimensional space extending between2.0 cm and 6.0 cm in three dimensions from the forearm home position.The type and/or arrangements of joints at the mechanical joint 4042 candetermine the degrees of freedom of the forearm support 4008 relative tothe base 4004. The mechanical joint 4042, which is supported and/orbuilt on the central portion 4002 of the space joint 4006 can includeelastically-coupled components, sliders, journaled shafts, hinges,and/or rotary bearings, for example.

The degrees of freedom and the dimensions of the travel zone 4050 can beselected to provide the surgeon with first-person perspective control ofthe end effector (i.e. from the surgeon's perspective, being“positioned” at the jaws of the remotely-positioned end effector at thesurgical site). In various instances, motion of a handpiece 4020 on theinput control device 4000 can correspond to one-to-one correspondingmotion of the surgical end effector. For example, moving the handpiece4020 distally along the shaft axis S a distance of 1.0 cm can correspondto a distal displacement of the end effector a distance of 1.0 cm alongthe longitudinal shaft axis S of the surgical tool. Similarly, rotatingthe handpiece 4020 at a wrist or joint 4010 counterclockwise fivedegrees can correspond to a rotational displacement of the end effectorby five degrees in the counterclockwise direction. In various instances,the input control motions to the control input device 4000 can bescaled, as further described herein and in various co-owned applicationsthat have been incorporated by reference herein.

The input control device 4000 also includes a shaft 4012 extendingdistally from the forearm support 4008 and the handpiece 4020 extendingdistally from the shaft 4012. The forearm support 4008, the shaft 4012,and the handpiece 4020 form a collective unit 4011, which is movabletogether as the forearm support 4008 is moved relative to the base 4004within the travel zone 4050 defined by the mechanical joint 4042. Adisplacement sensor is configured to detect movement of the collectiveunit 4011. The handpiece 4020 defines an end effector actuator having atleast one jaw, as further described herein. The shaft 4012 includes alinear portion extending along the shaft axis S that is parallel to theaxis X in the configuration shown in FIG. 6. The shaft 4012 alsoincludes a contoured “gooseneck” portion 4018 that curves away from theshaft axis S to position the handpiece 4020 in a comfortable positionand orientation for the surgeon relative to the forearm support 4008.For example, the contoured portion 4018 defines a curvature of about 90degrees. In other instances, the curvature can be less than 90 degreesor more than 90 degrees and can be selected based on the surgeon'spreference(s) and/or anthropometrics, for example.

The shaft 4012 supports the wrist 4010 intermediate the linear portionand the contoured portion 4018. For example, the wrist 4010 can bepositioned at the distal end of the linear portion, such that thecontoured portion 4018 is configured to rotate relative to the linearportion upon application of manual control motions thereto. The wrist4010 is longitudinally offset from the space joint 4006. The wrist 4010defines a mechanical joint to facilitate rotary motion. The wrist 4010can include elastically-coupled components, sliders, journaled shafts,hinges, and/or rotary bearings, for example. The wrist 4010 can alsoinclude a rotary sensor (e.g. the sensor 1049 in FIG. 25), which can bea rotary force/torque sensor and/or transducer, rotary strain gauge,strain gauge on a spring, rotary encoder, and/or an optical sensor todetect rotary displacement at the joint, for example.

The wrist 4010 can define input control motions for at least one degreeof freedom. For example, the wrist 4010 can define the input controlmotions for the rolling motion of a robotic end effector controlled bythe input control device 4000. Rotation of the wrist 4010 by the surgeonto roll an end effector provides control of the rolling motion at thesurgeon's fingertips and corresponds to a first-person perspectivecontrol of the end effector (i.e. from the surgeon's perspective, being“positioned” at the jaws of the remotely-positioned end effector at thesurgical site). As further described herein, such placement andperspective can be utilized to supply precision control motions to theinput control device 4000 during portions of a surgical procedure (e.g.a precision motion mode).

In certain instances, the input control device 4000 can includeadditional wristed joints. For example, the shaft 4012 can include oneor more additional rotary joints along the length thereof, such as at ajuncture or junction 4014 (FIG. 44) along a linear portion of the shaft4012 and/or at a juncture or junction 4016 at the distal end of thecontoured portion 4018 of the shaft 4012. For example, a mechanicaljoint at the junction 4016 can permit articulation of the handpiece 4020relative to the shaft 4012 about at least one axis. In variousinstances, the handpiece 4020 can be articulated about at least two axes(e.g. the axis Z₁ that is parallel to the axis Z in FIG. 45 and the axisY₁ that is parallel to the axis Yin FIG. 45). The additional joints canprovide additional degrees of freedom for the input control device 4000,which can detected by a sensor arrangement and converted to rotary inputcontrol motions for the end effector, such as a yawing or pitchingarticulation of the end effector. Such an arrangement requires one ormore additional sensor arrangements to detect the rotary input at thejunction 4016, for example.

As further described herein, the space joint 4006 can define the inputcontrol motions for multiple degrees of freedom. For example, the spacejoint 4006 can define the input control motions for translation of thesurgical tool in three-dimensional space and rotation of the surgicaltool about at least one axis. Rolling motions can be controlled byinputs to the space joint 4006 and/or the wrist 4010. Whether a rollingcontrol motion is provided by the wrist 4010 or the space joint 4006 ofthe input control device 4000 can depend on the actions of the surgeonand/or the operational mode of the input control device 4000, as furtherdescribed herein. Articulation motions can be controlled by inputs tothe space joint 4006 and/or the junction 4016. Whether an articulationcontrol motion is provided by the junction 4016 or the space joint 4006of the input control device 4000 can depend on the actions of thesurgeon and/or the operational mode of the input control device 4000, asfurther described herein.

The handpiece 4020 includes an end effector actuator having opposingfingers 4022 extending distally from the shaft 4012. The opposingfingers 4022 can be similar to the fingers 1022 (FIGS. 6-11) in manyrespects. Applying an actuation force to the opposing fingers 4022comprises an input control motion for a surgical tool. For example,referring again to FIG. 12, applying a pinching force to the opposingfingers 4022 can close and/or clamp the jaws 1054 of the end effector1052 (see arrows C in FIG. 12). In various instances, applying aspreading force can open and/or release the jaws 1054 of the endeffector 1052, such as for a spread dissection task, for example. Thefingers 4022 also includes loops 4030, which are similar to the loops1030 (FIGS. 6-11) in many respects. The opposing fingers 4022 can bedisplaced symmetrically or asymmetrically relative to the longitudinalshaft axis S during an actuation. The displacement of the opposingfingers 4022 can depend on the force applied by the surgeon, forexample, and a desired surgical function. The input control device 4000includes at least one additional actuator, such as the actuation buttons4026, 4028, for example, which can provide additional controls at thesurgeon's fingertips, e.g. the surgeon's index finger I, similar to theactuation buttons 1026, 1028 (FIGS. 6-11) in many respects. The readerwill appreciate that the actuation buttons 4026, 4028 can have differentgeometries and/or structures, and can include a trigger, a button, aswitch, a lever, a toggle, and combinations thereof.

Referring primarily to FIGS. 48 and 49, during use, a surgeon canposition a portion of his or her arm on the forearm support 4008 and canprovide forces to the space joint 4006 via inputs at the forearm support4008. The surgeon's forearm can be positioned on the lower portion ofthe forearm support 4008 and a cuff or sleeve of the forearm support4008 can at least partially surround the surgeon's arm in certaininstances. For example, the forearm support 4008 forms a partial loophaving a curvature of more than 180 degrees. In certain instances, thecurvature can define an arc of approximately 270 degrees, for example.In other instances, the cuff or sleeve can form an enclosed loop throughwhich the surgeon can position his or her arm. Alternative geometriesfor the forearm support are envisioned. The surgeon's thumb T ispositioned through one of the loops 4030 and the surgeon's middle fingerM is positioned through the other loop 4030. In such instances, thesurgeon can pinch and/or spread his thumb T and middle finger M toactuate the opposing fingers 4022. The distally-extending fingers 4022(for actuation of the jaws) and the actuation buttons 4026, 4028 (foractuation of a surgical function at the jaws) are distal to the spacejoint 4006 and wrist 4010. Such a configuration mirrors theconfiguration of a surgical tool in which the end effector is distal tothe more-proximal articulation joint(s) and/or rotatable shaft and,thus, provides an intuitive arrangement that facilitates a surgeon'straining and adoption of the input control device 4000.

In various instances, the input controls for the input control device4000 are segmented between first control motions and second controlmotions, similar in many aspects to the operational modes described withrespect to the input control device 1000 (FIGS. 6-11). Control logic forthe input control device 4000 can be utilized in the control circuit 832(FIG. 25), the control circuit 1400 (FIG. 11C), the combinationallogical circuit 1410 (FIG. 11D), and/or the sequential logic circuit1420 (FIG. 11E), for example, where an input is provided from inputs tothe input control device 4000 and/or a surgical visualization system ordistance determining subsystem thereof, as further described herein.Inputs from the input control device 4000 include feedback from thevarious sensors thereof and related to control inputs at the space joint4006, the wrist 4010, and/or the handpiece 4020, for example.

Referring now to FIG. 50, control logic 4068 for the input controldevice 4000 can activate or maintain a gross motion mode at a block 4082if the distance (d_(t)) determined by a distance determining subsystemis greater than or equal to a threshold distance (D_(critical)) and candeactivate the gross motion mode at a block 4076 if the distance WO isless than the threshold distance (D_(critical)). More specifically, whena force is initially applied to the forearm support 4008 to move theforearm support 4008 to the end of its constrained travel zone (e.g. aboundary of the travel zone 4050 in FIG. 47) at a block 4070, therobotic surgical tool is controlled to move at a surgical site relativeto relevant tissue at a block 4072. In various instances, the forcerequired to input control motions via the sensor arrangement 4048 (FIG.46) can be greater than the force required to move the forearm support4008 to the end of its travel zone. In other words, the surgeon can movethe forearm support 4008 to the ends of its travel zone before effectingcontrol motions with the sensor arrangement 4048.

As the robotic surgical tool is moved relative to tissue, the controllogic checks proximity data provided by a tissue proximity detectionsystem to determine if the distance (d_(t)) is greater than or equal toa threshold distance (D_(critical)) at a block 4074. The control logic4068 can periodically and/or continuously compare the distance (d_(t))to the threshold distance (D_(critical)) during the surgical procedure(e.g. intraoperatively and/or in real-time). The threshold distance(D_(critical)) can be set by the surgeon in certain instances. Moreover,the surgeon may selectively override the default rules and conditions ofthe control logic 4068, such as the rules related to the comparison at ablock 4074 and/or adjustments to the threshold distance (D_(critical)),for example.

If the distance (d_(t)) is greater than or equal to the thresholddistance (D_(critical)), the gross motion mode can be activated at ablock 4082. As a force continues to be applied to the forearm support4008 to move the forearm support 4008 to the end of its constrainedtravel zone (the block 4070) and moves the tool relative to tissue (theblock 4072), the control circuit can continue to monitor the distance(d_(t)) (the block 4074) and maintain the gross motion mode (block 4082)while the distance (d_(t)) is greater than or equal to the thresholddistance (D_(critical)).

If the distance (d_(t)) becomes less than the threshold distance(D_(critical)), the gross motion mode can be deactivated at a block4076. With the gross motion mode deactivated, control motions for therobotic tool can be controlled with limited translation of the forearmsupport 4008 within the travel zone at a block 4078 (e.g. the travelzone 4050 in FIG. 47) and/or with the actuations to the wrist(s) (e.g.the wrist 4010 and/or the junction 4016) and/or to the handpiece 4020 ata block 4080. The control circuit can continue to monitor the distance(d_(t)) (the block 4074) and deactivate the gross motion mode (the block4076) as long as the distance (d_(t)) is less than the thresholddistance (D_(critical)).

During the gross motion mode, the surgical tool and end effector thereofcan be driven in the directions detected by the forces at the spacejoint 4006 and applied by the forearm support 4008 until the forces areremoved and the central portion 4002 is biased back to the homeposition. Upon removal of the forces to the space joint 4006 during thegross motion mode, the driving forces supplied to the end effector canterminate as well.

Referring again to FIGS. 44-49, the input control device 4000 has beendescribed as having a mechanical joint 4042 intermediate the space joint4006 and the forearm support 4008, which permits movement of the forearmsupport 4008 (and the entire collective unit 4011) relative to the base4004 within the travel zone 4050. The travel zone 4050 can provide aprecision control zone for the surgeon to move the handpiece 4020 tosupply precision control motions to an end effector. In other instances,similar to the input control device 1000, for example, the input controldevice 4000 may not include the additional mechanical joint 4042intermediate the space joint 4006 and the forearm support 4008. In suchinstances, precision control motions can be applied to the space joint4006; however, such control motions can be scaled according to data froma tissue proximity detection system as further described herein. Scalingalgorithms can also be applied to the input control device 4000, forexample.

Feedback

Surgeons may like to receive feedback during a robotic surgicalprocedure. Feedback can indicate a changed condition of the controlsystem, such as a changed operational mode of an input control device,for example, and/or an updated condition at the surgical site, such asproximity data regarding the robotic surgical tool relative to tissueand/or relative to another robotic surgical tool and/or robotic arm, forexample. Feedback can also be related to the condition of the patient,elapsed time during the surgical procedure or particular steps thereof,and/or an error state of the robotic surgical system and/or roboticsurgical tool. Without instantaneous, or nearly instantaneous,indication of certain conditions directly to the surgeon, the surgeonmay be unprepared and/or require an extended reaction and/or adjustmentperiod, which may extend the duration of the surgical procedure. It canbe challenging to provide such feedback directly to the surgeon duringthe surgical procedure, especially in instances in which a surgeon ispositioned away from the surgeon's console and/or is not looking at thedisplay screen of the surgeon's console.

An input control device can provide feedback to the surgeon to indicatea changed condition of the control system and/or an updated condition atthe surgical site. For example, an input control device incorporatingfeedback capabilities may alert a surgeon when the control system hasswitched between operational modes, such as between a gross motion modeand a precision motion mode, for example. Additionally or alternatively,an input control device incorporating feedback capabilities may provideproximity alerts to the surgeon. In various instances, a proximitydetection system communicatively coupled to the input control device canrelay the proximity data to the various clutchless input control devicesdisclosed herein. Feedback can be provided intraoperatively and inreal-time. In certain instances, the feedback can be provided to thesurgeon via the input control device regardless of the surgeon'sposition within the operating room and/or without requiring a surgeon'sconsole and/or display screen, for example. In such instances, thesurgeon can obtain instantaneous, or nearly instantaneous, indicationsand/or alerts, which can enable the surgeon to react in a timely mannerand/or to adjust his or her input control motions to the input controldevice accordingly.

Referring now to FIG. 51, control logic 6068 for an input controldevice, such as the input control device 4000 (FIGS. 44-49), forexample, is shown. The control logic 6068 includes the logic blocks4070, 4072, 4074, 4076, 4078, 4080, and 4082 described herein withrespect to FIG. 50. Additionally, the control logic 6068 includes ablock 6084 following a determination that the distance (d_(t)) is lessthan the threshold distance (D_(critical)) at the block 4074. Based onthe tissue proximity data, the gross motion mode is deactivated at theblock 4076. Feedback is provided to the surgeon via the input controldevice at the block 6084. In various instances, blocks 6084 and 4076 canbe implemented concurrently or nearly concurrently. Block 6084 canimmediately precede block 4076 and/or block 4076 can immediately precedeblock 6084. By providing feedback at the block 6084, the surgeon can benotified and/or alerted to the changed operational mode of the inputcontrol device and can adjust his or her input control motionsaccordingly.

The feedback provided at the block 6084 can include tactile feedback,visual feedback, and/or auditory feedback, for example. Tactile feedbackincludes vibratory buzzing, clicking, scalable resistance forces, and/orother haptic feedback; visual feedback includes an illuminated lightand/or light pattern and/or alert(s) provided via an LED and/or displayscreen on the input control device; and auditory feedback includesnoises like beeping, humming, and/or computer-generated verbal warningsand/or notifications.

In various instances, an input control device having feedbackcapabilities can include a feedback generator, which is configured togenerate vibratory or haptic feedback and provide feedback, such as abuzz and/or series of buzzes, for example, to the surgeon utilizing theinput control device. An input control device 6100 is shown in FIG. 52.The input control device 6100 can be similar to the input control device4000 (FIGS. 44-49) in many respects. In certain instances, the inputcontrol device 6100 can be identical to the input control device 4000except that the input control device 6100 also includes at least onefeedback generator and the associated control circuits. The feedbackgenerators can be positioned to provide feedback to the surgeon holdingand/or engaged with the input control device 6100. Exemplary feedbackgenerators 6180 a, 6180 b, 6180 c are embedded in the input controldevice 6100. For example, the feedback generator 6180 a is positioned inthe forearm support 4008, the feedback generator 6180 b is positioned inthe shaft 4012, and the feedback generator 6180 c is positioned in theopposing fingers 4022 of jaw on the handpiece 4020. In variousinstances, a feedback generator can be positioned in each opposingfinger 4022 of the handpiece 4020. The reader will appreciate that thefeedback generators 6180 a, 6180 b, and 6180 c can be positioned atalternative locations in the input control device 6100 (e.g. proximal tothe wrist along the shaft 4012 and/or within the base 4004 of the inputcontrol device 6100). Moreover, in various instances, the input controldevice 6100 can include less than three feedback generators or more thanthree feedback generators. Additionally or alternatively, feedback canbe provided by speakers, LEDs, and/or screens, for example, positionedon an outer surface of the input control device 6100.

Referring now to FIG. 53, travel zones for the input control device 6100are shown. The travel zones include an inner precision motion zone 6150,and an outer gross motion zone 6152. The precision motion zone 6150 cancorrespond to the travel zone 4050 for the input control device 4000shown in FIG. 47. For example, the forearm support 4008 (or supportingshaft thereof) is configured to move within the precision motion zone6150 to supply input control motions to the robotic surgical tool. Uponreaching the end of the precision motion zone 6150, an increased forceapplied to the forearm support 4008 can move the supporting shaftthereof into the gross motion zone 6152.

The precision motion zone 6150 and the gross motion zone 6152 defineconcentric rings having different radial distances. The precision motionzone 6150 is defined or bounded by an inner boundary 6151 and an outerboundary 6153. A radial distance or width (d_(precision)) spans thespace between the inner boundary 6151 and the outer boundary 6153. Thegross motion zone 6152 is defined or bounded by an inner boundary 6155and an outer boundary 6157. A radial distance or width (d_(gross)) spansthe space between the inner boundary 6155 and the outer boundary 6157.In various instances, the inner boundary 6155 of the gross motion zone6152 can be collinear with the outer boundary 6153 of the precisionmotion zone 6150.

The radial distance (d_(precision)) defining the precision motion zone6150 is larger than the radial distance (d_(gross)) defining the grossmotion mode. For example, the radial distance (d_(precision)) for theprecision motion mode 6150 can be between 2.0 cm and 6.0 cm, and theradial distance (d_(gross)) for the gross motion mode 6152 can bebetween 1.0 mm and 5.0 mm. In certain instances, the radial distance(d_(precision)) of the precision motion zone 6150 can be at least anorder of magnitude larger than the radial distance (d_(gross)) of thegross motion zone 6152. Although the zones 6150, 6152 are depicted asplanar, two-dimensional zones in FIG. 53, the reader will appreciatethat the zones 6150, 6152 can define three-dimensional zones in variousinstances. In still other instances, the forearm support 4008 can bemovable along a single axis and, in such instances, the zones 6150, 6152can define one-dimensional paths.

In various instances, the feedback generators (e.g. one of thegenerators 6180 a, 6180 b, and 6180 c in FIG. 52) can be configured toprovide feedback when the forearm support 4008 approaches and/or reachesthe boundary between the precision motion zone 6150 and gross motionzone 6152. In certain instances, the feedback generators can providedifferent types, degrees, and/or patterns of feedback. For example, afirst type of feedback can be provided as the forearm support 4008approaches the boundary between the precision motion zone 6150 and thegross motion zone 6152, and a different type of feedback can be providedas the forearm support 4008 crosses the boundary The different types offeedback can provide additional information to the surgeon, which canfacilitate the surgeon's decision-making process and/or planning

Feedback can be provided at the various boundaries of the differentzones and/or different operational modes of the user input device 6100.As further described herein, the various input control devices caninclude multiple joints, including multi-dimensional space joints andwrists, among other joints. Feedback can be provided to the surgeon whenany joint limit is approached and/or met. In certain instances, thefeedback can include a resistance force that increases as the jointlimit is met, such as when the forearm support 4008 moves away from thehome position and approaches the boundary 6153, 6155 between theprecision motion zone 6150 and the gross motion zone 6152.

In certain instances, referring again to FIG. 52, the input controldevice 6100 includes at least one detent arrangement for providingtactile feedback to the surgeon. For example, the input control device6100 includes a detent arrangement 6182 intermediate the base 4004 andthe forearm support 4008. The detent arrangement 6182 can be positionedat the limit or boundary 6153, 6155 (FIG. 53) between the precisionmotion zone 6150 and the gross motion zone 6152. In such instances, whenthe force exerted by the surgeon on the forearm support 4008 moves theforearm support 4008 from the precision motion mode 6150 to the grossmotion mode 6152, the detent arrangement 6182 can provide a tactileindication to the surgeon that the input control device 6100 hastransitioned to gross motion control. For example, the detentarrangement 6182 can include a notch and a spring-loaded element, suchas a pin, pawl, dog, and/or ball, for example. The notch can be definedin the base 4004 and the spring-loaded element can be supported by theforearm support 4008, for example. As the forearm support 4008 is pushedby the surgeon, the spring-loaded element can engage the notch and betemporarily restrained until a larger force exerted on the forearmsupport 4008 moves the spring-loaded element past the notch. Thegeometry of the notch and/or the interplay between the notch and thespring-loaded element can control the amount of resistance andcorresponding tactile force delivered to the surgeon. In variousinstances, a row of notches can provide tactile feedback and/or clickingat more than one location, and, in certain instances, different notchgeometries can provide different types of feedback at the differentlocations.

In various instances, the forearm support 4008 can be biased toward thecentral home position within the precision motion zone 6150. Forexample, a spring arrangement can bias the forearm support 4008 towardthe center of the concentric rings shown in FIG. 53. In certaininstances, the spring arrangement can include a dampener configured todampen or prevent “snap-back” vibrations.

Feedback generators can be incorporated into alternative input controldevices. For example, feedback generators can be incorporated into inputcontrol devices having different geometries and/or configurations.Moreover, feedback generators can be incorporated into a wireless and/oruntethered input control device and/or modular handpiece portion of aninput control device. As another example, an input control device 6200is shown in FIG. 54. The input control device 6200 can be similar to theinput control device 1000 (FIGS. 6-11) in many respects. In certaininstances, the input control device 6200 can be identical to the inputcontrol device 1000 except that the input control device 6200 alsoincludes at least one feedback generator and the associated controlcircuits. The feedback generators can be positioned to provide feedbackto the surgeon holding and/or engaged with the input control device6200. Exemplary feedback generators 6280 a and 6280 b are embedded inthe input control device 6200. For example, the feedback generator 6280a is positioned in the end effector actuator 1020 and, specifically inone of the opposing fingers 1022. In certain instances, a feedbackgenerator can be positioned in both opposing fingers 1022. Additionally,the feedback generator 6180 b is positioned in the joystick 1008. Thereader will appreciate that the feedback generators 6280 a and 6280 bcan be positioned at alternative locations in the input control device6100 (e.g. in the wrist 1010, the shaft 1012, and/or within the base1004) of the input control device 6200. Moreover, in various instances,the input control device 6200 can include less than two feedbackgenerators or more than two feedback generators.

In various instances, the feedback generators for an input controldevice, such as the feedback generators 6180 a, 6180 b, 6180 c, 6280 a,and 6280 b (FIGS. 52 and 53), for example, can be haptic feedbackgenerators, which generate vibratory motion of the input control deviceor a component thereof. Such vibratory motions can be detected, observedand/or felt by the surgeon using the input control device. For example,the feedback generators can create vibratory/haptic feedback using aneccentric rotating mass (ERM) actuator, which includes an unbalancedweight attached to a motor shaft. As the shaft rotates, the spinning ofthis irregular mass causes the actuator, and in turn, the input controldevice and/or component thereof, to shake, buzz, or vibrate. Alternativehaptic feedback generators can utilize a linear resonant actuator (LRA),which can reciprocate a mass along a linear path utilizing a magneticcoil, and piezoelectric actuators, among other feedback generators, forexample. Because various input control devices described herein do notrely on electromagnetic (EM) tracking to determine the input controlmotions supplied and delivered by the surgeon, mechanical actuators andmotors for generating tactile, haptic feedback can be incorporated intosuch input control devices without interfering with the controllingcapabilities thereof.

In various instances, the feedback generators can provide vibratoryand/or buzzing feedback to indicate a changed condition, as describedherein. In other instances, the input control device can include forcefeedback generators, which are configured to generate a force andpositioned to deliver the force to the surgeon. For example, the forearmsupport 4008 can exert a scaled resistance as the forearm support 4008moves toward the gross motion zone 6152. In one aspect, the scaledresistance can increase as the forearm support 4008 moves toward thegross motion zone 6152. In another aspect, the opposing fingers 4022 canbe configured to exert a scaled (e.g. increasing) resistance force asthe opposing fingers 4022 approach a joint limit thereof and/or approacheach other to clamp the tissue, for example.

In still other aspects, the input control device can receive proximitydata regarding the proximity of the surgical tool controlled by theinput control device with respect to other surgical tools and/or roboticarms at the surgical site. For example, the control system for the inputcontrol device can alert the surgeon when the controlled surgical toolis in close proximity to another surgical tool and/or robotic arm. Thefeedback can be provided as at least one of the various tactile,auditory, and/or visual feedbacks described herein.

Additionally or alternatively, the various feedback actuators describedherein in connection with the input control devices 6100 and 6200, forexample, can be utilized to communicate a patient alert and/or an errorstate to the surgeon. Error states include errors to the robotic systemand/or the robotic surgical tool, which can occur when a roboticsurgical tool is attached to the robotic arm improperly, when therobotic surgical tool is loaded incorrectly and/or positioned out ofline, and/or when the robotic surgical tool is fired improperly, forexample. Alerts can also be provided to the surgeon based on the elapsedtime and/or the physiological condition of the patient. For example,during certain time-sensitive procedures, the condition of the patientcan depend on the duration of the procedure. A surgeon may want toreceive feedback and/or alerts regarding the condition of the patientand/or the amount of elapsed time. For example, alerts provided directlyto the surgeon via the input control device engaged by the surgeon canbe used during video-assisted thoracic (VAT) procedures, Pringlemaneuvers during a liver procedure to prevent a Pringle blood occlusion,or during a nephrectomy when a bulldog clamp procedure is used totemporarily stop the flow of blood. The feedback can be provided as atleast one of the various tactile, auditory, and/or visual feedbacksdescribed herein.

The various feedback data, alerts, and/or error states described hereincan also be communicated to the surgeon via the monitor 1088 at theadjustable workspace 1080 (FIGS. 16 and 17). In such instances, theinformation can be communicated to the surgeon, as well as otherpersonnel in the surgical theater and/or positioned to view the monitor1088.

Surgeons utilizing surgical robots to perform a surgical procedure mayappreciate tactile feedback that corresponds to one or more conditionsat the surgical site. For example, the input control device(s) utilizedby the surgeon(s) during the surgical procedure may receive feedbacksignals from the surgical robot corresponding to conditions experiencedby a surgical tool at the surgical site. As an example, the surgicaltool may experience a force or pressure from the tissue clamped betweenthe jaws of the end effector. Such a tissue force can depend on variouscharacteristics of the tissue, including the type, thickness, density,and/or toughness of the tissue, for example. A surgeon may want tomonitor the force exerted by the tissue on the jaws to ensure the tissueis not subjected to excessive forces, which may traumatize and/or damagecertain tissue, and/or subjected to insufficient forces, which maycorrespond to unsatisfactory staple formation and/or tissue seals.

As described herein, various input control devices for robotic surgicaltools can include a pair of opposing jaws or fingers that correspond tothe opposing jaws of the end effector of the robotic surgical tool. Theopposing jaws can extend distally with respect to an articulation jointor wrist of the input control device mirroring the configuration of arobotic surgical tool having an articulation joint along the shaft andjaws extending distally from the shaft. To affect opening or closingmotions of one or more of the end effector jaws, the surgeon can applycorresponding opening or closing motions to the appropriatejaw(s)/opposing fingers of the input control device. In such instances,the opposing fingers of the input control device can provide anintuitive actuator for controlling the end effector jaws. In variousinstances, a surgeon may appreciate force feedback at the opposingfingers of the input control device that corresponds to the force of thetissue on the end effector jaws. Such an arrangement can provideintraoperative, dynamic feedback to the surgeon during the surgicalprocedure. Moreover, such feedback can be proportionate and commensuratewith the input control motions applied to the input control device.

For example, in one aspect, a control system can include a robotic toolconfigured to detect a property of a tissue at a surgical site. Thecontrol system can also include an input control device and a controlcircuit. The input control device can include a base, a joystick coupledto the base, and a handpiece coupled to the joystick, wherein thehandpiece includes a variable resistance assembly comprising a piston.The variable resistance assembly can also include an energized coil,wherein output control signals to the variable resistance assembly areconfigured to adjust a current supplied to the energized coil. Thehandpiece can also include a linear actuator configured to translate thepiston, which can be a magnetic element, relative to the energized coil.The handpiece can also include a first jaw coupled to the piston and asecond jaw coupled to the piston, wherein the first jaw and the secondjaw are configured to receive user input control motions. The controlcircuit can be configured to receive jaw control signals indicative ofthe user input control motions received by the first jaw and the secondjaw, provide first output control signals to the robotic tool based onthe jaw control signals, receive tissue property signals indicative ofthe property of the tissue, and provide second output control signals tothe variable resistance assembly in response to the property of thetissue. Alternative variable resistance assemblies and arrangementsthereof are further described herein.

Referring now to FIG. 55, an input control device 7000 is shown. Theinput control device 7000 can be similar to the input control device1000 (FIGS. 6-11) in many respects. In certain instances, the inputcontrol device 7000 can be identical to the input control device 1000except that the input control device 7000 also includes a variableresistance assembly 7080 and the associated control circuits. Forexample, the input control device 7000 includes the base 1004, the spacejoint 1006, the joystick 1008, and the end effector actuator orhandpiece 1020. The input control device 7000 also includes the wrist1010, which is offset from the space joint 1006 by a shaft 7012extending along a shaft axis S that is parallel to the axis X in theconfiguration shown in FIG. 55. For example, the joystick 1008 canextend upright vertically from the central portion 1002 and the base1004, and the joystick 1008 can support the shaft 7012.

The shaft 7012 includes the variable resistance assembly 7080. Thevariable resistance assembly 7080 can be secured to the shaft 7012and/or retained within a central channel within the shaft 7012. Thevariable resistance assembly 7080 is configured to generate a variablespring rate or resistance forces (F_(R1) and F_(R2)) utilizingelectromagnetic induction. The resistance forces (F_(R1) and F_(R2)) areapplied to the opposing fingers 1022, such as by a pair of linkages 7023extending between the opposing fingers 1022 and the variable resistanceassembly 7080.

The variable resistance assembly 7080 can be an electromagnetic forcegenerator. For example, the variable resistance assembly 7080 includes amagnetic piston 7084 and a coil 7082, which can be formed from aconductive wire or plurality of conductive wires that are coupled to apower source and energized by an electric current therethrough. Themagnetic piston 7084 is movably supported relative to the coil 7082. Forexample, the piston 7084 can be supported by a linear actuator. Thevariable resistance forces (F_(R1) and F_(R2)) can be controlled by themovement of the piston 7084 relative to the coil 7082. For example, thepiston 7084 can be moved along and/or within a portion of the length ofthe coil 7082. By adjusting the current through the coil 7082, themagnetic force around the piston 7084 can change, which can apply aforce to displace the piston 7084. Stated differently, the variablecurrent affects the resistance of the piston 7084 to translationrelative to the coil 7082. The spring rate and/or resistance forces(F_(R1) and F_(R2)) are, thus, magnetically controlled by theelectromagnetic force, which is affected by the current supplied to thecoil 7082.

The input control device 7000 also includes a pair of connectors 7085extending between the variable resistance assembly 7080 and each linkage7023. For example, the linkages 7023 can connect the magnetic piston7084 of the resistance assembly 7080 to the opposing fingers 1022.Movement of the fingers 1022, such as by a surgeon applying an actuationclosure motion to the fingers 1022, for example, is configured to movethe linkages 7023 coupled thereto and, thus, apply a force to themagnetic piston 7084 of the resistance assembly 7080. In alternativeaspects, the linear actuator for the resistance assembly 7080 caninclude additional linkages, screws, such as friction screws withanti-backlash nuts and/or ball screws, belt and pulley systems, rack andpinion systems, a piezoelectric actuator, and/or alternative motorsarrangements.

The variable resistance assembly 7080 is configured to provideresistance to both fingers 1022 of the input control device 7000.Conversely, existing handheld surgical instruments, such as a powered,handheld surgical stapler, for example, may only include a singletrigger for actuating the end effector jaws and, thus, only generate aresistance force on the single trigger even though multiple end effectorjaws are actuated and/or utilized to clamp the tissue. In thearrangement depicted in FIG. 55, the resistance forces (F_(R1) andF_(R2)) are equal. In other instances, the resistance forces (F_(R1) andF_(R2)) can be independent, as further described herein.

The resistance forces (F_(R1) and F_(R2)) can correspond to the forcefrom tissue engaged by the opposing end effector jaws. Referring now toFIG. 56, a graphical representation 7086 of voltage (V) in the coil 7082of the variable resistance assembly 7080 relative to the tissue force(F_(tissue)) is shown. The voltage (V) is proportional to the tissueforce (F_(tissue)). As the magnetic piston 7084 moves relative to thecoil 7082, a voltage can be induced in the coil 7082. The magnitude ofthe induced voltage is proportional to the velocity of the relativemovement between the magnetic piston 7084 and the coil 7082. A graphicalrepresentation 7088 of the resistance force (F_(R)) applied to theopposing fingers 1022 relative to the tissue force (F_(tissue)) is shownin FIG. 57. The resistance force (F_(R)) is proportional to the tissueforce (F_(tissue)). In other instances, a stepped or non-linearresistance force (F_(R)) can be generated in response to the changingtissue force (F_(tissue)).

Referring now to FIG. 58, control logic 7090 for an input controldevice, such as the input control device 7000 (FIG. 55), for example, isconfigured to adjust the resistance forces (F_(R1) and F_(R2)) appliedto the end effector actuators, such as the opposing fingers 1022, forexample. The control logic 7090 can be utilized in the control circuit832 (FIG. 25), the control circuit 1400 (FIG. 11C), the combinationallogical circuit 1410 (FIG. 11D), and/or the sequential logic circuit1420 (FIG. 11E), for example. At a block 7092, the tissue force(F_(tissue)) at the end effector is determined. The tissue force(F_(tissue)) can be detected by measuring the current drawn by a motorduring the closing or tissue clamping motion of the end effector. Agreater amount of current can correspond to a greater tissue force(F_(tissue)), for example. At a block 7094, the tissue force(F_(tissue)) can be communicated to a control circuit for the inputcontrol device. In response to the detected and communicated tissueforce (F_(tissue)), the control circuit can adjust the resistance force(F_(R)) applied to the fingers 1022 at a block 7096. The blocks 7092,7094, 7096 can be repeated to update the resistance force (F_(R)) inresponse to a changing tissue force (F_(tissue)).

In certain instances, the control logic 7090 can be configured tocommunicate additional and/or alternative information to the surgeon viathe input control device 7000 (FIG. 55). For example, the control logic7090 can communicate contact of a robotic surgical tool controlled bythe input control device 7000 with an anatomical structure or tissue atthe surgical site. In such instances, a sensor (e.g. a capacitivesensor) on the robotic surgical tool can be configured to detect contactwith tissue. Upon detecting such contact, the input control device 7000can adjust a resistance force applied to the fingers 1022 of the inputcontrol device 7000, utilizing the variable resistance assembly 7080,for example.

In certain instances, a variable resistance assembly for an inputcontrol device can include at least one motor configured to applyadjustable resistance forces to the end effector actuators thereof. Forexample, an input control device can include a pair of variableresistance assemblies that are movable independently. The variableresistance assemblies can constitute electric motors and/or linearactuators. For example, the control system can use a motor to physicallyadjust (increase or decrease) the force required to actuate the fingers1022 in order to apply closure motions to the end effector jaws. Theforce adjustment can depend on the force profile at the end effector ofthe robotic surgical tool.

In certain instances, the resistance forces (F_(R1) and F_(R2)) appliedto the fingers 1022 can be independent. Depending upon the orientationand position of the surgical end effector at the surgical site, theforces exerted on the end effectors jaws could be different and, in suchinstances, the independent resistance assemblies could apply differentresistance forces to the respective fingers of the input control device.

Additionally or alternatively, the variable force profile generated bythe variable resistance assembly can be tool-specific. For example, fora first surgical tool the variable force profile can include at leastone peak and dip before the end of the stroke, and for a second surgicaltool the variable force profile can include a single peak at the end ofthe stroke. The first surgical tool can be an ultrasonic device, forexample, having at least two bistability states during a closure stroke.Upon advancing the closure stroke over-center between bistable states,the force profile generated by the variable resistance assembly canpeak. The force profile can subsequently drop in the second bistablestate before the end of the closure stroke. The second surgical tool canbe a grasper, for example, defining a linear force profile during aclosure stroke. In such instances, the variable force profile generatedand delivered by the variable resistance assembly can be selected basedon the surgical tool that is operably coupled to and controlled by theinput control device. Alternative force profiles (e.g. stepped, curved,wavy, sinusoidal, and/or exponential) are also contemplated. The forceprofile can be selected based on the geometry and/or design of thesurgical tool and/or the expectations of the surgeon, for example. Invarious instances, the variable resistance force can be selected tomatch or coordinate with the variable resistance force delivered to thesurgeon using the corresponding non-robotic, handheld surgical tool.

Various input control devices described herein do not rely on EMtracking and, thus, the input control devices can incorporate motors andother feedback generators utilizing magnetic elements to providefeedback without interfering with the control signals for the inputcontrol device.

Often, multiple surgical tools are utilized during a robotic surgicalprocedure. Surgical tools can flow in and out of use and/or can bereleasably attached to an arm of the surgical robot. In one instance, afirst robotic tool can be utilized during an initial portion of thesurgical procedure and can be subsequently replaced, or exchanged, for asecond robotic tool during a later portion of the surgical procedure.Tool swapping is common during complex surgical procedures. In oneinstance, a bipolar tool can be replaced with a monopolar tool, anultrasonic tool, a grasper, a stapler, a suction tool and/or anirrigation tool, for example. In certain instances, a clinician locatedwithin the sterile field is positioned to swap or exchange the surgicaltools attached to a robotic arm.

Additionally or alternatively, a single input control device can beselectively paired to different surgical tools. In one aspect, theworkspace for the surgeon may include fewer active input control devicesthan robotic arms. For example, the workspace may have two input controldevices, one for each of the surgeon's hands; however, the surgicalrobot may include more than two robotic arms. In such instances, a inputcontrol device can be selectively paired to surgical tools coupled todifferent robotic arms.

When an input control device is paired with different surgicaltools—e.g., when surgical tools are either exchanged or control by aninput control device switches between different robotic arms/surgicaltools—the orientation of the input control device may not correspond to,or match, the orientation of the second surgical tool. As an example,the jaws of a first surgical tool can be driven to a closed orientationby an input control device. When a second surgical tool is paired tothat same input control device, the jaws of the second surgical tool maybe in an open orientation and, thus, may not match the closedorientation of the jaw actuator on the input control device. In suchinstances, though the second surgical tool paired with the input controldevice is configured to receive closure motions, the jaw actuator of theinput control device may be unable to receive further closure motionsand, thus, cannot receive input control motions to close the jaws of thesecond surgical tool. Additionally or alternatively, when theorientation of the input control device does not correspond to theorientation of the paired surgical tool, the actuation of other inputcontrol motions, such as articulation control motions, for example, maybe inhibited or limited and/or positioned in a less intuitiveconfiguration or arrangement for the surgeon.

In various instances, an input control device can be configured toreceive control motions based on the position of the surgical toolpaired with the input control device. For example, when the position ofa portion of a surgical tool does not match the position of thecorresponding actuator on the input control device, the actuator can bedriven to a suitable position that corresponds with the orientation ofthe portion of the surgical tool. The input control device can include alinear actuator, for example, which is configured to move one or more ofthe jaws of the input control device to match the angular orientation ofthe one or more jaws of the surgical tool paired with the input controldevice. In one aspect, a control system for a robotic surgical systemcan include a control circuit configured to receive first input controlsignals indicative of user input control motions received by a movableactuator on an input control device, provide first output controlsignals to a robotic tool based on the first input control signals,receive second input control signals from the robotic tool indicative ofthe position of a movable element of the robotic tool, and providesecond output control signals to a linear actuator of the input controldevice based on the second input control signals.

By matching the position of the drivable actuator on the input controldevice to the driven element on the robotic surgical tool, the flow ofsurgical tools during a surgical procedure can be improved. For example,an input control device can switch between controlling a first surgicaltool and a second surgical tool with minimal interruptions and/orwithout requiring the direct involvement of the surgeon and/or otherclinicians in the surgical theater. For example, the control circuit canautomatically adjust the position of one or more drivable actuators onan input control device upon pairing of a surgical tool with the inputcontrol device. In such instances, the transition can be seamless andefficient, for example. Moreover, in various instances, the controlcircuit can continuously and/or periodically check that the position ofthe drivable actuator in the input control device corresponds to theposition of the driven element on the robotic surgical tool andimplement a closed-loop adjustment to match the positions. Additionallyor alternatively, the control circuit can provide an alert and/or errormessage to the surgeon via the various feedback systems described hereinwhen the positions do not match and/or do not fall within a range ofacceptable positions.

Referring now to FIG. 59, an input control device 8000 is shown. Theinput control device 8000 can be similar to the input control device1000 (FIGS. 6-11) in many respects. In certain instances, the inputcontrol device 8000 can be identical to the input control device 1000except that the input control device 8000 also includes a jaw actuationassembly 8080 and the associated control circuits. For example, theinput control device 8000 includes the base 1004, the space joint 1006,the joystick 1008, and the end effector actuator or handpiece 1020. Theinput control device 8000 also includes the wrist 1010, which is offsetfrom the space joint 1006 by a shaft 8012 extending along a shaft axis Sthat is parallel to the axis X in the configuration shown in FIG. 59.For example, the joystick 1008 can extend upright vertically from thecentral portion 1002 and the base 1004, and the joystick 1008 cansupport the shaft 8012.

The shaft 8012 includes the jaw actuation assembly 8080. The jawactuation assembly 8080 can be secured to the shaft 8012 and/or retainedwithin a central channel in the shaft 8012. The jaw actuation assembly8080 is configured to drive the fingers 1022 on the handpiece 1020 inresponse to input control signals indicative of a position ororientation of the jaw(s) on the robotic surgical tool paired with theinput control device 8000.

The jaw actuation assembly 8080 includes a linear actuator 8081, whichis configured to apply opening and closing motions to the fingers 1022.For example, the linear actuator 8081 includes a reciprocating element8082 that is pivotably connected to connecting rods 8084. Eachconnecting rod 8084 is pivotably connected to one of the fingers 1022.With such an arrangement, longitudinal displacement of the reciprocatingelement 8082 by the linear actuator 8081 is configured to pivot thefingers 1022 about the wrist 1010. For example, as the reciprocatingelement 8082 is drawn proximally (in the proximal direction PD) towardthe wrist 1010, the fingers 1022 are configured to pivot outwardly todefine an increased angle θ_(C) therebetween. Similarly, as thereciprocating element 8082 is pushed distally (in the distal directionDD) away from the wrist 1010, the fingers 1022 are configured to pivotinwardly to define a decreased angle θ_(C) therebetween.

The angular orientation of the fingers 1022 and, thus the angle θ_(C)defined between the fingers 1022, is adjusted by the linear actuator8081. In various instances, the linear actuator 8081 can include a rackand pinion system, which can be operably connected to a servomechanismFor example, referring now to FIG. 60, the linear actuator 8081 for thejaw actuation assembly 8080 can include a rack 8182 operably connectedto a servomechanism through a gear 8184 and/or gear train. Alternativelinear actuators for the jaw actuation assembly 8080 are contemplated.For example, the linear actuator can include one or more linear motors,hydraulic and/or pneumatic actuators, screws, such as friction screwswith anti-backlash nuts and/or ball screws, belt and pulley systems,rack and pinion systems, and/or piezoelectric actuators.

In various instances, the linear actuator 8081 is configured to driveboth fingers 1022 of the handpiece 1020. In the symmetrical arrangementof FIG. 59, the fingers 1022 can be pivoted equally in response to anactuation of the linear actuator 8081. In other instances, the fingers1022 can be asymmetrically actuated in response to an actuation of alinear actuator. In still other instances, the jaw actuation assembly8080 can include more than one linear actuator. Referring now to FIG.61, a jaw actuation assembly 8280 including a pair of linear actuators8281 is shown. The jaw actuation assembly 8280 can be utilized with aninput control device, such as the input control device 8000, forexample. Each linear actuator 8281 can be coupled to one of the fingersof the input control device (e.g. the fingers 1022 in FIG. 59) by aconnecting rod 8284 such that the rotational displacement of each finger1022 is independently controlled by the independent linear displacementof respective reciprocating elements 8282 of the linear actuators 8281.

The jaw actuation assembly 8080 is configured to drive the fingers 1022of the input control device 8000 to a desired angular orientation. Forexample, the linear actuator 8081 can be actuated to automatically matchthe position or orientation of the fingers 1022 to the position ororientation of the jaws on a robotic surgical tool. Referring now toFIG. 62, a table 8090 provides corresponding positions for the endeffector actuators on an input control device, such as the fingers 1022on the input control device 8000 (FIG. 59), for example, and the jaws ofa robotic surgical tools, such as the opposing jaws 1064 of the endeffector 1062 (FIGS. 13A, 14A, and 15A), for example, throughout asurgical procedure involving the swapping or surgical tools.

For example, with Tool #1 paired with the input control device, thefingers on the input control device can transition from an angle θ_(C1),an open controller configuration, to an angle 74 _(C2), apartially-closed controller configuration, to drive the jaws of Tool #1from an angle θ_(T1), an open tool configuration, to an angle θ_(T2), apartially-closed tool configuration. The angle θ_(C1) corresponds to theangle θ_(T1), and the angle θ_(C2) corresponds to the angle θ_(T2). Invarious instances, corresponding angles can match or be equal. Continuedactuations of the fingers of the input control device can continue toadjust the angular orientation of the jaws of Tool #1.

At a later time, the input control device may be paired with a differentsurgical tool, such as Tool #2 or Tool #3. Upon pairing the inputcontrol device with Tool #2, which has its jaws oriented at an angleθ_(T3), a closed tool configuration in which the jaws are not angularlyoffset from one another, the fingers on the input control device can bedriven inwardly to an angle θ_(C3), a closed controller configuration,which corresponds to the angle θ_(T3). Subsequently or alternatively,the input control device can be paired with Tool #3, which has its jawsoriented at the angle θ_(T1), the open tool configuration. Upon pairingwith Tool #3, the fingers on the input control device can be drivenoutwardly to the angle θ_(C1), the open controller configuration. Thereader will appreciate that alternative surgical tools and angularpositions are contemplated. In certain instances, the jaw actuationassembly 8080 and the linear actuator 8081 of FIG. 59 can be configuredto affect the drive motions to the input control device shown in FIG.62. In other instances, alternative linear actuators can be employed.

Referring now to FIG. 63, control logic 8100 for an input controldevice, such as the input control device 8000 (FIG. 59), for example, isconfigured to selectively drive robotic surgical tools in response tocontrol signals from the input control device and to selectively drivethe input control device in response to control signals from the roboticsurgical tool. The angles referenced in the control logic 8100 cancorrespond to the angles shown in the table 8090 (FIG. 62). The controllogic 8100 can selectively drive the end effector actuators, such as theopposing fingers 1022, for example, to correspond to the detectedposition of the jaws of the robotic surgical tool. The control logic8100 can be utilized in the control circuit 832 (FIG. 25), the controlcircuit 1400 (FIG. 11C), the combinational logical circuit 1410 (FIG.11D), and/or the sequential logic circuit 1420 (FIG. 11E), for example.

At a block 8102, the input control device defines the angle θ_(C1)between the end effector actuators. At a block 8104, the control logic8100 is configured to check the robotic surgical tool paired with theinput control device and match the angle between the end effectoractuators to the angle defined between the opposing jaws of the pairedrobotic surgical tool. For example, if the robotic surgical tool pairedwith the input control device defines the angle θ_(T1) between the jaws,the fingers of the input control device can remain in the same position.At the outset of the surgical procedure and/or when a new surgical toolis detected by or paired with the input control device, the controllogic can automatically coordinate the angles such that the anglebetween the end effector actuators corresponds to the angle definedbetween the opposing jaws of the paired robotic surgical tool.

At a block 8106, the input control device—upon receiving an inputcontrol motion from a surgeon that, for example, moves the end effectoractuators of the input control device—is configured to drive the jaws ofthe robotic surgical tool from angle θ_(T1) to the angle θ_(T2) as theend effector actuators move through a corresponding range of motion, orcorresponding degrees, from the angle θ_(C1) to the angle θ_(C2) at theblock 8108. In certain instances, a surgeon may activate a single endeffector actuator and/or can pivot the end effector actuatorsasymmetrically and the jaw(s) of the robotic surgical tool can be drivenaccordingly. For example, certain surgical tools may only utilize asingle moving jaw, which can pivot relative to a fixed jaw, for example.In such instances, one of the end effector actuators can remainstationary while the other end effector actuator moves. In certaininstances, the end effector actuator representing a fixed jaw can beselectively locked out when the input control device is paired with sucha surgical tool. In still other instances, different surgical tools candefine different ranges of motions. For example, depending on thegeometry of an articulation assembly and/or pivot joint, the jaw(s) ofone surgical tool can have a larger range of motion than the jaw(s) ofanother surgical tool. Upon pairing of the input control device with asurgical tool, the range of motion of the end effector actuators can beselectively restrained to correspond to the range of motion of thesurgical tool. For example, a portion of the range of motion of an endeffector actuator on an input control device can be locked out when therobotic surgical tool paired with the input control device has a morelimited range of motion.

At a block 8110, the robotic surgical tool paired with the input controldevice can be swapped for a different surgical tool. Swapping ofsurgical tools can constitute the physical removal of one surgical toolfrom a robotic arm and the attachment of another surgical tool to therobotic arm. Additionally or alternatively, swapping surgical tools canconstitute pairing or establishing communication paths with a differentsurgical tool, which may be attached to a different robotic arm, forexample. Swapping of the surgical tools can be initiated by a clinicianwithin the sterile field or by a control input to the surgical robot,such as a command provided by the surgeon to the input control deviceand/or at the surgeon's console, for example.

At a block 8112, the previous surgical tool has been exchanged for Tool#2. Tool #2 can be an entirely different type of surgical tool, asimilar tool having different features/capabilities, or the same type ofsurgical tool in a different configuration, for example. At the block8112, Tool #2 defines the angle θ_(T3) between the jaws. Referring againto FIG. 62, the angle θ_(T3) corresponds to a closed jaw position inwhich the angle between the jaws is zero. At a block 8114, the endeffector actuators of the input control device are driven inwardly to anew angular orientation, the angle θ_(C3), a closed controllerconfiguration in which the angle between the opposing fingers is zero,which corresponds to the angle Θ_(T3). Upon matching the angle betweenthe end effector actuators to the angle defined between the opposingjaws of Tool #2, the input control device is ready to receive inputcontrol motions and the control circuit can supply output controlsignals to Tool #2 based on the input control motions applied to theinput control device by the surgeon. For example, at a block 8116, theinput control device drives Tool #2 from the angle θ_(T3) to the angleθ_(T2). As a result, the input control device can again define the angleθ_(C2) and can continue controlling the robotic surgical tool at a block8108 through the surgical procedure or until another “tool swap” occursat the block 8110.

At a block 8118, Tool #3 has replaced the previous surgical tool. Tool#3 can be an entirely different type of surgical tool, a similar toolhaving different features/capabilities, or the same surgical tool in adifferent configuration, for example. At the block 8118, Tool #3 definesthe angle θ_(T1) between the jaws. Referring again to FIG. 62, the angleθ_(T1) corresponds to an open jaw position. At the block 8120, the endeffector actuators of the input control device are driven outwardly tothe angle θ_(C1), an open controller configuration that corresponds tothe angle θ_(Ta). Upon matching the angle between the end effectoractuators to the angle defined between the opposing jaws of Tool #3, theinput control device is ready to receive input control motions and thecontrol circuit can supply output control signals to Tool #3 based onthe input control motions applied to the input control device by theclinician. For example, at the block 8106, the input control devicedrives Tool #3 from the angle θ_(T1) to the angle θ_(T2). As a result,the input control device can again define the angle θ_(C2) and cancontinue controlling Tool #3 at the block 8108 through the surgicalprocedure or until another “tool swap” occurs at the block 8110.

In various instances, the various jaw actuator systems and linearactuators described herein can be utilized to effect a training mode, inwhich input control motions applied to the input control device can belimited. For example, the jaw actuation system 8080 and the linearactuator 8081 (FIG. 59) can draw the opposing fingers 1022 inwardlytoward the shaft 8012 to form a secondary control portion, column, orvirtual shaft, which can define a non-jaw actuation control portion, forexample. Training modes and secondary control portions are furtherdescribed in Attorney Docket No. END9054USNP1/180622-1, titled SEGMENTEDCONTROL INPUTS FOR SURGICAL ROBOTIC SYSTEMS, which has been incorporatedby reference herein in its entirety.

EXAMPLES

Various aspects of the subject matter described herein are set out inthe following numbered examples.

A list of Examples follows:

-   -   Example 1—A control system for a robotic surgical system, the        control system comprising a surgical tool movable with respect        to a tissue of a patient, an input control device configured to        receive an input control motion. The input control device        comprises a feedback generator. The control system further        comprises a control circuit configured to receive an input        control signal indicative of the input control motion received        by the input control device, provide a first output control        signal to the surgical tool based on the input control signal,        determine a distance between the surgical tool and the tissue,        and provide a second output control signal to the feedback        generator based on the distance reaching a threshold distance.    -   Example 2—The control system of Example 1, wherein the input        control device further comprises a handpiece. The feedback        generator is embedded in the handpiece.    -   Example 3—The control system of Example 1, wherein the input        control device further comprises a forearm support. The feedback        generator is embedded in the forearm support.    -   Example 4—The control system of any one of Examples 1-3, wherein        the feedback generator is configured to deliver haptic feedback        to a surgeon upon receiving the second output control signal.    -   Example 5—The control system of any one of Examples 1-4, wherein        the feedback generator comprises an eccentric rotating mass        actuator.    -   Example 6—The control system of any one of Examples 1-4, wherein        the feedback generator comprises a resistance generator        configured to deliver a variable resistance based on the        distance approaching the threshold distance.    -   Example 7—The control system of any one of Examples 1-6, wherein        the feedback generator is configured to generate visual feedback        upon receiving the second output control signal.    -   Example 8—The control system of any one of Examples 1-7, wherein        the feedback generator is configured to produce an auditory        signal upon receiving the second output control signal.    -   Example 9—A control system for a robotic surgical system, the        control system comprising a surgical tool movable with respect        to a tissue of a patient, an input control device comprising a        base and a forearm support, and a control circuit. The forearm        support is movable relative to the base within a first zone upon        receipt of a precision input control motion to the forearm        support. The forearm support is moveable relative to the base        within a second zone upon receipt of a gross input control        motion to the forearm support. The input control device further        comprises a feedback generator. The control circuit is        configured to receive an input control signal indicative of the        precision input control motion and the gross input control        motion, provide an output control signal to the surgical tool        based on the input control signal, and provide a feedback signal        to the feedback generator in response to the forearm support        transitioning between the first zone and the second zone.    -   Example 10—The control system of Example 9, further comprising a        proximity detection system configured to detect a distance        between the surgical tool and the tissue. The gross input        control motion is ignored by the control circuit when the        distance between the surgical tool and the tissue is less than a        threshold distance.    -   Example 11—The control system of Examples 9 or 10, wherein the        first zone and the second zone comprise concentric zones. The        first zone is surrounded by the second zone.    -   Example 12—The control system of any one of Examples 9-11,        wherein the first zone comprises a first inner boundary, a first        outer boundary, and a first radial width spanning from the first        inner boundary to the first outer boundary The second zone        comprises a second inner boundary collinear with the first outer        boundary, a second outer boundary, and a second radial width        spanning from the second inner boundary to the second outer        boundary The second radial width is less than the first radial        width    -   Example 13—The control system of any one of Examples 9-12,        wherein the input control device further comprises a detent        arrangement positioned to provide tactile feedback to a user of        the input control device when the user applies the gross input        control motion to move the forearm support from the first zone        to the second zone.    -   Example 14—The control system of any one of Examples 9-13,        wherein the feedback generator is embedded in the forearm        support.    -   Example 15—The control system of any one of Examples 9-13,        wherein the input control device further comprises a shaft        extending distally from the forearm support. The feedback        generator is embedded in the shaft.    -   Example 16—A control system for a robotic surgical system, the        control system comprising an input control device configured to        receive input control motions. The input control device is        configured to operate in a first operational mode and a second        operational mode. The input control device comprises a feedback        generator. The control system further comprises a control        circuit configured to receive input control signals indicative        of the input control motions received by the input control        device, switch the input control device between the first        operational mode and the second operational mode, provide first        output control signals based on the input control signals in the        first operational mode and provide second output control signals        based on the input control signals in the second operational        mode, and provide a feedback signal to the feedback generator in        response to the input control device switching between the first        operational mode and the second operational mode. The second        output control signals are different than the first output        control signals.    -   Example 17—The control system of Example 16, wherein the first        operational mode comprises a precision motion mode and the        second operational mode comprises a gross motion mode.    -   Example 18—The control system of Examples 16 or 17, further        comprising a proximity detection system configured to detect a        distance between a component of the robotic surgical system and        a tissue. The control circuit is configured to switch the input        control device between the first operational mode and the second        operational mode when the proximity detection system detects the        distance is less than a threshold distance.    -   Example 19—The control system of Example 18, wherein the        proximity detection system comprises a structured light emitter        and an optical receiver.    -   Example 20—The control system of any one of Examples 16-19,        wherein the input control device further comprises a first        component, a second component, and a joint intermediate the        first component and the second component. The second component        is configured to receive the input control motions. The second        component is configured to move at the joint within a range of        motion relative to the first component. The control circuit is        further configured to provide a second feedback signal to the        feedback generator in response to the second component        approaching a limit of the range of motion at the joint.

Another list of Examples follows:

-   -   Example 1—A control system for a robotic surgical system, the        control system comprising a robotic tool configured to detect a        property of a tissue at a surgical site and an input control        device comprising a base, a joystick coupled to the base, and a        handpiece coupled to the joystick. The handpiece comprises a        variable resistance assembly comprising a piston, a first jaw        coupled to the piston, and a second jaw coupled to the piston.        The first jaw and the second jaw are configured to receive user        input control motions. The control system further comprises a        control circuit configured to receive a jaw control signal        indicative of the user input control motions received by the        first jaw and the second jaw, provide a first output control        signal to the robotic tool based on the jaw control signal,        receive a tissue property signal indicative of the property of        the tissue, and provide a second output control signal to the        variable resistance assembly based on the tissue property        signal.    -   Example 2—The control system of Example 1, wherein the variable        resistance assembly further comprises an energized coil. The        piston comprises a magnet configured to translate relative to        the energized coil.    -   Example 3—The control system of Example 2, wherein the second        output control signal to the variable resistance assembly is        configured to adjust a current supplied to the energized coil.    -   Example 4—The control system of any one of Examples 1-3, wherein        the handpiece further comprises a shaft. The first jaw and the        second jaw are pivotably coupled to the shaft and the piston is        configured to move along the shaft.    -   Example 5—The control system of Example 4, wherein the shaft        comprises a linear actuator configured to effect a linear        displacement of the piston in response to a pivotal displacement        of the first jaw and the second jaw.    -   Example 6—The control system of any one of Examples 1-5, wherein        the robotic tool further comprises a pair of end effector jaws.        The property of the tissue comprises a pressure exerted on the        pair of end effector jaws engaged with the tissue.    -   Example 7—The control system of Example 6, wherein the robotic        tool further comprises a current sensor configured to detect a        current drawn by a motor configured to actuate the pair of end        effector jaws engaged with the tissue.    -   Example 8—A control system for a robotic surgical system, the        control system comprising a robotic tool configured to detect a        property of a tissue at a surgical site and an input control        device comprising a base, a joystick coupled to the base, and a        handpiece coupled to the joystick. The handpiece comprises a        variable resistance assembly comprising a piston and a jaw        coupled to the piston. The jaw is configured to receive a user        input control motion. The control system further comprises a        control circuit configured to receive a jaw control signal        indicative of the user input control motion received by the jaw,        provide a first output control signal to the robotic tool based        on the jaw control signal, receive a tissue property signal        indicative of the property of the tissue, and provide a second        output control signal to the variable resistance assembly based        on the property of the tissue.    -   Example 9—The control system of Example 8, wherein the variable        resistance assembly further comprises an energized coil. The        piston comprises a magnet configured to translate relative to        the energized coil.    -   Example 10—The control system of Example 9, wherein the second        output control signal to the variable resistance assembly is        configured to adjust a current supplied to the energized coil.    -   Example 11—The control system of any one of Examples 8-10,        wherein the variable resistance assembly comprises an electric        motor.    -   Example 12—The control system of any one of Examples 8-11,        wherein the handpiece further comprises a second variable        resistance assembly comprising a second piston and a second jaw        coupled to the second piston. The second jaw is configured to        receive a second user input control motion.    -   Example 13—The control system of any one of Examples 8-12,        wherein the robotic tool further comprises a pair of end        effector jaws. The property of the tissue comprises a force        exerted on the pair of end effector jaws clamping the tissue.    -   Example 14—The control system of Example 13, wherein the robotic        tool further comprises a current sensor configured to detect a        current drawn by a motor configured to actuate the pair of end        effector jaws engaged with the tissue.    -   Example 15—A control system for a robotic surgical system, the        control system comprising an input control device comprising a        base, a joystick coupled to the base, and a handpiece coupled to        the joystick. The handpiece comprises a variable resistance        assembly comprising a piston, a first jaw coupled to the piston,        and a second jaw coupled to the piston. The first jaw and the        second jaw are configured to receive user input control motions.        The control system further comprises a control circuit        configured to receive jaw control signals indicative of the user        input control motions received by the first jaw and the second        jaw, provide first output control signals to a robotic tool of        the robotic surgical system based on the jaw control signals,        receive tissue property signals indicative of a tissue property,        and provide second output control signals to the variable        resistance assembly based on the tissue property.    -   Example 16—The control system of Example 15, wherein the        variable resistance assembly further comprises an energized        coil. The piston comprises a magnet configured to translate        relative to the energized coil.    -   Example 17—The control system of Example 16, wherein the second        output control signals to the variable resistance assembly are        configured to adjust a current supplied to the energized coil.    -   Example 18—The control system of any one of Examples 15-17,        wherein the handpiece further comprises a shaft. The first jaw        and the second jaw are pivotably coupled to the shaft and the        piston is configured to move along the shaft.    -   Example 19—The control system of Example 18, wherein the shaft        comprises a linear actuator configured to effect a linear        displacement of the piston in response to a pivotal displacement        of the first jaw and the second jaw.    -   Example 20—The control system of any one of Examples 15-19,        wherein the variable resistance assembly comprises an electric        motor.

Another list of Examples follows:

-   -   Example 1—A control system for a robotic surgical system, the        control system comprising a robotic tool comprising a tool jaw        movable through a range of positions and an input control        device. The input control device comprises a linear actuator and        a pivotable jaw coupled to the linear actuator. The pivotable        jaw is configured to pivot in response to a user input control        motion and the linear actuator is configured to selectively        pivot the pivotable jaw. The control system further comprises a        control circuit configured to receive a first input control        signal indicative of the user input control motion received by        the pivotable jaw, provide a first output control signal to the        robotic tool based on the first input control signal, receive a        second input control signal from the robotic tool indicative of        the position of the tool jaw within the range of positions, and        provide a second output control signal to the linear actuator        based on the second input control signal.    -   Example 2—The control system of Example 1, wherein the second        output control signal is configured to match the angular        orientation of the pivotable jaw to the angular orientation of        the tool jaw.    -   Example 3—The control system of Examples 1 or 2, wherein the        linear actuator comprises a rack and a servomechanism operably        coupled to the rack.    -   Example 4—The control system of Examples 1 or 2, wherein the        linear actuator comprises a reciprocating element and a first        connector pivotably coupled to the pivotable jaw and the        reciprocating element.    -   Example 5—The control system of any one of Examples 1-4, wherein        the robotic tool further comprises a second tool jaw moveable        through a second range of positions. The input control device        further comprises a second pivotable jaw coupled to the linear        actuator. The second pivotable jaw is configured to pivot in        response to the user input control motion and the linear        actuator is configured to selectively pivot the second pivotable        jaw.    -   Example 6—The control system of any one of Examples 1-4, wherein        the robotic tool further comprises a second tool jaw moveable        through a second range of positions. The input control device        further comprises a second linear actuator and a second        pivotable jaw coupled to the second linear actuator.    -   Example 7—The control system of Example 6, wherein the linear        actuator is independent of the second linear actuator.    -   Example 8—The control system of Examples 6 or 7, wherein the        control circuit is further configured to receive a third input        control signal indicative of the user input control motion        received by the second pivotable jaw, provide a third output        control signal to the robotic tool based on the third input        control signal, receive a fourth input control signal from the        robotic tool indicative of the position of the second pivotable        jaw within the second range of positions, and provide a fourth        output control signal to the second linear actuator based on the        fourth input control signal.    -   Example 9—A control system for controlling a robotic surgical        tool, the control system comprising an input control device        comprising a base, a joystick extending from the base, and a        handpiece extending from the joystick. The handpiece comprises a        linear actuator, a first controller jaw coupled to the linear        actuator, and a second controller jaw coupled to the linear        actuator. The first controller jaw and the second controller jaw        are configured to receive user input control motions and the        linear actuator is configured to selectively drive the first        controller jaw and the second controller jaw. The control system        further comprises a control circuit configured to receive first        input control signals indicative of user input control motions        received by the first controller jaw and the second controller        jaw, provide first output control signals to the robotic        surgical tool based on the first input control signals, receive        second input control signals from the robotic surgical tool        indicative of a position of a first tool jaw and a second tool        jaw of the robotic surgical tool, and provide second output        control signals to the linear actuator based on the second input        control signals    -   Example 10—The control system of Example 9, wherein the second        output control signals are configured to match the position of        the first controller jaw to the position of the first tool jaw        and the position of the second controller jaw to the position of        the second tool jaw.    -   Example 11—The control system of Example 9, wherein the second        output control signals are configured to match a controller        angle between the first controller jaw and the second controller        jaw to a tool angle between the first tool jaw and the second        tool jaw.    -   Example 12—The control system of any one of Examples 9-11,        wherein the linear actuator comprises a rack and a servomotor        operably coupled to the rack.    -   Example 13—The control system of any one of Examples 9-11,        wherein the linear actuator comprises a reciprocating element, a        first connector pivotably coupled to the first controller jaw        and the reciprocating element, and a second connector pivotably        coupled to the second controller jaw and the reciprocating        element.    -   Example 14—A control system for a robotic surgical system, the        control system comprising a robotic tool comprising a tool jaw        movable through a range of positions and a sensor configured to        detect the position of the tool jaw within the range of        positions. The control system further comprises a control        circuit configured to receive a first input control signal        indicative of a user input control motion received by an input        jaw of an input control device, drive the tool jaw to an        actuated position within the range of positions based on the        first input control signal, receive a second input control        signal from the robotic tool indicative of the position of the        tool jaw within the range of positions, and provide an output        control signal to drive the input jaw of the input control        device based on the second input control signal.    -   Example 15—The control system of Example 14, wherein the sensor        comprises a rotary encoder.    -   Example 16—The control system of Examples 14 or 15, wherein the        robotic tool further comprises a second tool jaw moveable        through a second range of positions and a second sensor        configured to detect the position of the second tool jaw within        the second range of positions.    -   Example 17—The control system of Example 16, wherein the control        circuit is further configured to receive a third input control        signal indicative of user input control motion received by a        second input jaw of the input control device, drive the second        tool jaw to an actuated position within the second range of        positions based on the third input control signal, receive a        fourth input control signal from the robotic tool indicative of        the position of the second tool jaw within the second range of        positions, and provide a second output control signal to drive        the second input jaw of the input control device based on the        fourth input control signal.    -   Example 18—A method comprising receiving a first input control        signal indicative of a user input control motion applied to a        controller jaw of an input control device, driving a jaw of a        first robotic tool in response to the first input control        signal, switching operable control by the input control device        from the first robotic tool to a second robotic tool, receiving        a second input control signal from the second robotic tool        indicative of an angular orientation of a jaw of the second        robotic tool, and driving the controller jaw of the input        control device to correspond to the angular orientation of the        jaw of the second robotic tool in response to the second input        control signal.    -   Example 19—The method of Example 18, further comprising        receiving a third input control signal from the second robotic        tool indicative of the angular orientation of a second jaw of        the second robotic tool and driving a second controller jaw of        the input control device to correspond to the angular        orientation of the second jaw of the second robotic tool in        response to the second input control signal.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e g , carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard Of course, different and/or after-developed connection-orientednetwork communication protocols are equally contemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e g , bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

What is claimed is:
 1. A control system for a robotic surgical system,the control system comprising: a surgical tool movable with respect to atissue of a patient; an input control device configured to receive aninput control motion, wherein the input control device comprises afeedback generator; and a control circuit configured to: receive aninput control signal indicative of the input control motion received bythe input control device; provide a first output control signal to thesurgical tool based on the input control signal; determine a distancebetween the surgical tool and the tissue; and provide a second outputcontrol signal to the feedback generator based on the distance reachinga threshold distance.
 2. The control system of claim 1, wherein theinput control device further comprises a handpiece, and wherein thefeedback generator is embedded in the handpiece.
 3. The control systemof claim 1, wherein the input control device further comprises a forearmsupport, and wherein the feedback generator is embedded in the forearmsupport.
 4. The control system of claim 1, wherein the feedbackgenerator is configured to deliver haptic feedback to a surgeon uponreceiving the second output control signal.
 5. The control system ofclaim 4, wherein the feedback generator comprises an eccentric rotatingmass actuator.
 6. The control system of claim 4, wherein the feedbackgenerator comprises a resistance generator configured to deliver avariable resistance based on the distance approaching the thresholddistance.
 7. The control system of claim 1, wherein the feedbackgenerator is configured to generate visual feedback upon receiving thesecond output control signal.
 8. The control system of claim 1, whereinthe feedback generator is configured to produce an auditory signal uponreceiving the second output control signal.
 9. A control system for arobotic surgical system, the control system comprising: a surgical toolmovable with respect to a tissue of a patient; an input control devicecomprising a base and a forearm support, wherein the forearm support ismovable relative to the base within a first zone upon receipt of aprecision input control motion to the forearm support, wherein theforearm support is moveable relative to the base within a second zoneupon receipt of a gross input control motion to the forearm support, andwherein the input control device further comprises a feedback generator;and a control circuit configured to: receive an input control signalindicative of the precision input control motion and the gross inputcontrol motion; provide an output control signal to the surgical toolbased on the input control signal; and provide a feedback signal to thefeedback generator in response to the forearm support transitioningbetween the first zone and the second zone.
 10. The control system ofclaim 9, further comprising a proximity detection system configured todetect a distance between the surgical tool and the tissue, wherein thegross input control motion is ignored by the control circuit when thedistance between the surgical tool and the tissue is less than athreshold distance.
 11. The control system of claim 9, wherein the firstzone and the second zone comprise concentric zones, and wherein thefirst zone is surrounded by the second zone.
 12. The control system ofclaim 9, wherein the first zone comprises: a first inner boundary; afirst outer boundary; and a first radial width spanning from the firstinner boundary to the first outer boundary; wherein the second zonecomprises: a second inner boundary collinear with the first outerboundary; a second outer boundary; and a second radial width spanningfrom the second inner boundary to the second outer boundary, wherein thesecond radial width is less than the first radial width.
 13. The controlsystem of claim 9, wherein the input control device further comprises adetent arrangement positioned to provide tactile feedback to a user ofthe input control device when the user applies the gross input controlmotion to move the forearm support from the first zone to the secondzone.
 14. The control system of claim 9, wherein the feedback generatoris embedded in the forearm support.
 15. The control system of claim 9,wherein the input control device further comprises a shaft extendingdistally from the forearm support, and wherein the feedback generator isembedded in the shaft.
 16. A control system for a robotic surgicalsystem, the control system comprising: an input control deviceconfigured to receive input control motions, wherein the input controldevice is configured to operate in a first operational mode and a secondoperational mode, and wherein the input control device comprises afeedback generator; and a control circuit configured to: receive inputcontrol signals indicative of the input control motions received by theinput control device; switch the input control device between the firstoperational mode and the second operational mode; provide first outputcontrol signals based on the input control signals in the firstoperational mode and provide second output control signals based on theinput control signals in the second operational mode, wherein the secondoutput control signals are different than the first output controlsignals; and provide a feedback signal to the feedback generator inresponse to the input control device switching between the firstoperational mode and the second operational mode.
 17. The control systemof claim 16, wherein the first operational mode comprises a precisionmotion mode, and wherein the second operational mode comprises a grossmotion mode.
 18. The control system of claim 16, further comprising aproximity detection system configured to detect a distance between acomponent of the robotic surgical system and a tissue, wherein thecontrol circuit is configured to switch the input control device betweenthe first operational mode and the second operational mode when theproximity detection system detects the distance is less than a thresholddistance.
 19. The control system of claim 18, wherein the proximitydetection system comprises a structured light emitter and an opticalreceiver.
 20. The control system of claim 16, wherein the input controldevice further comprises: a first component; a second component, whereinthe second component is configured to receive the input control motions;and a joint intermediate the first component and the second component,wherein the second component is configured to move at the joint within arange of motion relative to the first component; wherein the controlcircuit is further configured to provide a second feedback signal to thefeedback generator in response to the second component approaching alimit of the range of motion at the joint.